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MEDICAL

Inquiries and Obfervations :

CONTAINING

AN ACCOUNT

OF THE

YELLOW FEVER,

AS IT APPEARED IN PHILADELPHIA IN 1797,
AND

OBSERVATIONS

UPON THE

NATURE AND CURE

OF THE

Gout, and Hydrophobia.

BY BENJAMIN RUSH, M.D.

PROFESSOR OF MEDICINE IN THE UNIVERSITY
OF PENNSYLVANIA.

VOLUME V.

PHILADELPHIA

PRINTED BY BUDD AND BARTRAM,

FOR THOMAS DOBSON, AT THE STON^^HOfltKE,

N° 41, SOUTH SECOND /T-R^EET. *>S

_I798._/^ V\

' LIBRARY

Founded 1813
^%PI- OF MEDjg

drX^ksvd-^

PREFACE.

GREEABLY to my promife made in
the year 1796, I herewith offer to the public
a few obfervations upon the nature and cure
of the gout. They are connected with a hif-
tory of the yellow fever as it appeared in
Philadelphia in 1797, and with fome obfer-
vations upon the nature and cure of the hy-
drophobia. I ftill hold myfelf bound by my
promife at. the time above alluded to, to pub-
lifh the refult of my inquiries into the difeafes
of the mind. The extent and difficulties of
this interefting branch of medicine, will ne-
ceflarily delay this publication for fome time
to come. In the mean while (health and
life permitting) I fhall fpare no labour to
render it as ufeful as poffible.

IV THE PREFACE.

In my attempts to explain the nature of the
hydrophobia, I have affixed certain fpecific
ideas to feveral medical terms which I had
ufed in my former publications in the com-
mon and indefinite acceptation of authors.
The reader will excufe this liberty, wrhen
he refleds, how much new opinions
in other fciences, have been benefited
by a new nomenclature. Medicine in its
prefent improving ftate, muft follow thofe
fciences in adopting a new language, for
reason however impotent it may be for
ages, in producing juft effects in morals
and government, is feldom refilled longer
than a fingle generation, in the fcience which
relates to health and life. I am the more
confident of its influence in producing a
fpcedy revolution in the ufe of medical terms,
from having obferved the principles which
lead to it, adopted, not only by a number of
refpedfoible phyficians in this city and in the
neighbouring ftates, but by many ingenious
gentlemen of other profeffiens. <c 'Tis time
to retire" faid a Britifh general in the year
1 777, upon meeting an army of militia-men

upon

THE PREFACE. V

upon the heights of Saratoga. " The
owners of the foil have come forth." In
like manner, 'tis time for the impofing forms
of ignorance and error in medicine to hide
their heads. Unprejudiced men have come
forth in defence of their own lives. Their
efforts cannot fail of being fuccefsful, for they
are actuated not only by the powerful motive of
felf-prefervation, but they move by the light
of reafon, the advantages of which in medi-
cine, compared with folitary and mechanical
experience, are like the extenfive benefits the
fcience of navigation has derived from the
loadftone, compared with the feeble aids it
formerly derived from the fight of land, or
the tranfient light of the ftars.

BENJAMIN RUSH.

Philadelphia,
Atb July, 1798

CONTENTS.

Page.

F the weather, and dlfeafes which pre-
ceded the yellow fever of the year 1797 in the

years 1795 and 1796, 3

Of the firfl appearance of the fever in 1797, 11
Of the ftate of the weather as illuftrated by meteo-
rological obfervations made in the months of

Auguft, September, and October, - - 13

Of the prevalence of the fever in other places, 21

Of the difeafes which followed it, - - ibid.

Of its predifpofmg caufes, - - 22

Of its premonitory fymptoms - - 23
Of its fymptoms as they appeared

I. In the blood- veffels, - - - 23

II. in the excretions, - 24

III. in the nervous fyftem, - 26

IV. in the fenfes, - - 27

V. in the lymphatic fyftem, - 28

VI. ■ in the fkin, - - ibid.

VII. in the blood, - - ibid.

Of the different forms of the difeafe, - -31

Of the unity of the yellow and bilious fever, 35
Inftances of perfons who were twice and three times

affected by the fever, - - - 36

Account

Vlll CONTENTS,

Account of the effects of the contagion upon the au-
thor, and upon Dr. Dobell, - - 38
Means of preventing an attack of the fever, - 39
Number of deaths, - - - - 41
Account of the death of Dr. Way.
Letter from Governor MifHin to the author refpecting

the origin of the difeafe, - - 44

Anfwer to the faid letter, - - - 45

Memorial of the College of Phyficians to the Legifla-
ture of Pennfylvania. Narrative of facts relative to
the origin of the fever by the College, &c. Reply
to the faid memorial, and narrative of facts by the
, Academy of Medicine of Philadelphia, in a letter
to Governor Mifflin, 68

Appendix, containing documents and proofs of the do-
meftic origin of the yellow fever, by the Academy
of Medicine, - - - 81

An account of thofe vegetable and animal matters
which produce bilious, remitting, and malignant
feverf, - - - - - 100

Method of cure, - - - - 106

Of bleeding, - ibid.

Of purging, - - - - no

Of a falivation, - - - - m

Of the various ways in which mercury affected the

mouth and throat, - . - 113

Of the manner in which mercury is fuppofed to act in

the cure of malignant fevers, - - u^

Of vomits, - - - - 117

Of diet and drinks, - - - 118

Of tonic remedies, - - - 121

Of the ufe of fweet oil and of iffues as preventives

of the yellow fever, - - - 123, 124

CONTENTS. AX

Of the comparative fuccefs of depleting remedies
in the fever, - - - - 127

Of the figns of moderate danger, and a favour-
able iffue of the fever, - - 1 29

Of the figns of its great danger, and of an un-
favourable iffue.

Observations upon the Nature and Cure or

the Gout, ... - 139

Perfons moft fubject to it, - - - 140

Of its remote caufes, - - - 142

Of its exciting caufes, - - 143

Of its proximate caufe, - - 144

Of its fymptoms as they appear in the ligaments, 146

in the blood-veffels, - 147

in the vifcera, - - 149

in the arterial and -t

> nervous fyftems, J -*

in the mufcles, - - 152

in the alimentary canal, 153

in the glands and lymphatics, 155

onthefkin, - - 15R

in the bones, - - 159

Ufual and various effects of the gout in different

parts of the body, - - - 160

Of the method of cure, - - 162

I. Of obviating a fit of the gout in its forming flate, 1 64
II. Of the remedies that are proper in cafes of great

morbid action in the blood- veffels and vifcera, 1 65

Of blood-letting, - - - - 166

Of purging, ... . . ,7I

S CONTENTS.

Of vomits, - - - - 171

Of nitre, - - - 173

Of cool or cold air, - - ibid.

Of diluting liquors, - - - ibid.

Of abftinence, - - - - 174

Of Miners, .... ibid.

Of fear and terror, - - - 175

Of fweating, - ibid.

Of opium, - - - - 176

Of topical applications, - ibid.
Of the early ufe of the limbs after a fit of the

gout, - - - - 178
III. Of the remedies which are proper in that (late of
the gout in which a. feeble morbid action takes

place in the blood-veffels and vifcera, - 179

Of opium, wine, and porter, - - 180
Of ardent fpirits, - - - -181

Of aether, volatile alkali, oil of amber, and bark, 182

Of the warm bath and a falivation, - - 183
Of frictions to the ftomach and bowels, and of

ftimulating applications to the limbs, - 184
XV. Of the remedies for local fymptoms of the gout

without fever, - - - - 185

Of the head-ach and ophthalmia, - - 186

Of pains in the limbs and diarrhcea, - 187
Of angina pectoris, fpafms in the ftomach and

bowels, and pains in the rectum, - - 188
Of itching in the anus and vagina, cutaneous erup-
tions, and arthritic gonorrhaea, - 189
Inftances of the radical cure of the gout, 191
V. Of the means of preventing the return of the gout,

and firft of its violent degrees by temperance, 195

Of moderate labour and gentle exercife, - 196

CONTENTS, XI

Of avoiding cold, - - - 197

Of regulating the exercifes of the underflanding
and pailions, - - - ^199

Of avoiding excefs in the gratification of the vene-
real appetite, - ibid.

Of avoiding coftivenefs, - ibid.

Of occafional bleeding to prevent a fit of the gout, 200

Of Itiues and bitters, - - - 202

II. Of the means of preventing a return of that ftate
of gout which is attended with feeble morbid
action. ----- ibid.

Of a gently flimulating diet and the ufe of chaly-
beate medicines, - 203

Of the ufe of the vol. tincture of gum guaiacum,

and of garlic, ginger, and fafTafras, - 204

Of warmth, of the warm and cold bath, and of
regulating the ftate of the bowels and the exer-
cifes of the underflanding and paflions, - 205

Of a change of climate, - 206

Observations on the Nature and Cure of
the Hydrophobia, - 211

Of the remote caufes of the difeafe, - 212

Of the proximate caufe of ditto, as evidenced by
its caufes, fymptoms, &c. in dogs, - 215

Alfo by its caufes, fymptoms, &c. in the human
fpecies, - - - - 217

Of the remedies for hydrophobia.
I. Of fuch as are proper to prevent the difeafe after
the infection of the rabid animal is received into
the body, - - - - 225

Xll CONTENTS.

II. Of the remedies which are proper to cure it, 227

Of blood-letting, ... ibid.

Of purges and glyfters, - - - 231

Of fweating and a falivation, - - 232

Of tonic remedies, - ibid.

Of blifters and the cold bath, - - 233
Of the cure of the hydrophobia which occurs from

fear. - 236

A N

ACCOUNT

OF THE

BILIOUS, REMITTING, AND INTERMITTING

YELLOW FEVER,

AS IT APPEARED IN

PHILADELPHIA,

IN I797.

WTTOFMM

1813 J

ACCOUNT, &c.

|^N my account of the yellow fever, as it ap-
peared in Philadelphia in the year 1794, I tool:
notice of feveral cafes of it which occurred in the
fpring of the year 1795. Before I proceed to de-
liver the hiftory of this difeafe as it appeared in
1797, I fliall mention the difeafes and ftate of the
weather which occurred during the remaining part
of. the year 1795, and the whole of the year 1796.
This detail of facts, apparently uninterefling to the
reader in the prefent flate of our knowledge of
epidemics, may poffibly lead to principles at a fu-
ture day.

The month of April 1795 was wet, and cold.
All the difeafes of this month partook of the in-
flammatory character of the preceding winter and
B 2 autumn.

4 AN ACCOUNT OF THE

autumn, except the meafles which were unufually
mild.

The weather in May was alternately wet, cool,
and warm. A few cafes of malignant fever occur-
red this month, but with moderate fymptoms. In
June the weather was cool and pleafant. The
meafles put on more inflammatory fymptoms than in
the preceding months. I had two cafes of mania
under my care this month, and one of rheumatifm,
which were attended with intermifhons and exacer-
bations every other day.

The weather on the 19th, 20th, 2 ill, and 2 2d days
of July was very warm, the mercury being at 90 ° in
Farenheit's thermometer. The fevers of this month
were all accompanied with black difcharges from the
bowels. Mr. Kittera one of the reprefentatives
of Pennfylvania in the Congrefs of the United
States, in confequence of great fatigue on a warm
day, was affected with the ufual fymptoms of the
yellow fever. During his illnefs he conftantly com-
plained of more pain in the left, than in the right
fide of his head. His pulfe was more tenfe in his
left, than in his right arm. During his convale-
fcence, it was more quick in the left arm, than it
was in the right. He was cured by a falivation and
the lofs of above 100 ounces of blood. His head-

ach

BILIOUS YELLOW FEVER IN 1797. 5

ach was relieved by the application of a bladder
half filled with ice to his forehead.

Moft of the cafes of bilious fever which came
under my notice, were attended with quotidian,
tertian or quartan intermiflions. In a few of my
patients there was an univerfal ram.

Dr. Woodhoufe informed me, that he had feen
feveral inftances in which the yellow fever had been
taken from fome foldiers who had laboured under
the dyfentery. Thefe fa£h fhew the unity cf fe-
ver, and the impracticability of a nofological ar-
rangement of difeafes.

The cholera infantum was fevere and fatal in
many inftances during this month. It yielded to
bloodletting in a child of Mr. Gonyngham which
was but four months old. In a child of feven
weeks eld which came under my care, I obferved the
coldnefs, chills, hot fits, and remiifions of the bi-
lious fever to be as diftin&ly marked as ever I had
feen them in adult patients. In a child of Mr.
Darrach aged 5 months, the difcharges from the
bowels were of a black colour. I mention thefe
facts in fupport of an opinion I formerly publifhed,
that the cholera infantum is a bilious fever, and

that

6 AN ACCOUNT OF THE

that it riles and falls in its violence with the bilious
fever of grown perfons.

About the latter end of this month and the be-
ginning of Augufl, there were heavy fhowers of
rain which carried away fences, bridges, barns,
nulls and dwelling houfes in many places. Several
cafes of bilious yellow fever occurred in the month
of Auguit. In one of them it was accompanied
with that morbid affection in the wind-pipe which
has been called cynanche trachealis. It was re-
markable that fweating became a more frequent
fymptom of the fevers of this month than it had
been in July. Hippocrates afcribes this change in
the character of bilious fevers to rainy weather.
Perhaps it was induced by the rain which fell in
the beginning of the month, in the fevers which
have been named.

On the 30th and 31ft of Auguft there was a fall
of rain which fuddenly checked the fever of the
feafon, infomuch that the fucceeding autumnal
months were uncommonly healthy. Several fhow-
ers of rain had nearly the fame effect, in New- York
where this fever carried off in a few weeks above
700 perfons. It prevailed at the fame time, and
with great mortality, in the city of Norfolk in Vir-
ginia.

BILIOUS YELLOW FEVER IN 1797. 7

In both thofe cities as well as in Philadelphia the
difeafe was evidently derived from putrid exha-
lation.

In the fame month, the dyfentery prevailed in
Newhaven in Connecticut, and in the fame part of the
town in which the yellow fever had prevailed the
year before. The latter difeafe was faid to have
been imported, but the prevalence of the dyfentery
under the above circumftances, rendered it proba-
ble that both difeafes were of domeftic origin.

The fever as it appeared in Philadelphia yielded
in moft cafes to depleting remedies. After purging
and bloodletting, I gave bark where the fever
intermitted, with advantage. It was effectual, only
when given in large dofes. In one inftance it induced
a fpitting of blood which obliged me to lay it afide.

The winter of 1796 was uncommonly moderate.
There fell a good deal of rain, but little fnow.
The navigation of the Delaware was flopped but
two or three days during the whole fcafon. Ca-
tarrhs were frequent, but very few violent or acute
difeafes occurred in my practice. The month of
March and the firft week in April were uncommon-
ly dry. Several cafes of malignant bilious fever
came under my care during thefe months. In two

families

O AN ACCOUNT OF THE

families it appeared to be contagious. — A little girl
of five years old whom I loft in this fever, became
yellow in two hours after her death.

The meafles prevailed in April and were of a
moft inflammatory nature. The weather in May
and June was uncommonly wet. The fruit was
much injured, and a great deal of hay deftroyed by
it. On the 14th of June General Stewart died
with all the ufual fymptoms of a fatal yellow fever.
Several other cafes of yellow fever in this, and in
the fucceeding month, proved mortal, but they ex-
cited no alarm in the city, as the phyficians who at-
tended them, called them by other names.

The rain which fell about the middle of July check-
ed this fever. Auguft, September and October,
were unufually healthy. A few cafes of malignant
fore-throat appeared in November. They were in
all the patients that came under my notice, attended
with bilious difcharges from the ftomach, and bow-
els. So little rain fell during the autumnal months
that the wheat perifhed in many places. The wea-
ther in December was extremely cold. The lamps
of the city were in feveral inflances extinguifhed by
it on the night of the 23d of the month at which time
the mercury ftood at 2 ° below o in the thermome-
ter.

The

BILIOtfS YELLOW FEVER IN 1 797. 9

The yellow fever prevailed this year in Charlefton
in South Carolina, where it was produced by putrid
exhalations from the cellars of houfes which had been
lately burnt. It was faid by the phyficians of that
place not to be contagious. The fame fever prevailed
at the fame time at Wilmington in North Carolina,
and at Newbury port in the flate of Maffachufetts.
In the latter place it was produced by the exhalation
of putrid Mi which had been carelefsly thrown upon
a wharf. Mr. Webfler has difcovered that great
and extenfive peftilential difeafes, and earthquakes
or eruptions ofvolcanos, comets and meteors, general-
ly appear about at the fame time. Men of genius
and obfervation may perhaps difcover hereafter a
connection between certain phenomena in the hea-
vens of another kind, and a morbid confiitution of
the atmofphere. — The following narrative taken from
Mr. Brown's paper may ferve as a ray of light upon
this fubjecl.

For the PHILADELPHIA GAZETTE.

Mr. Brown,
I have juft taken up my pen to throw together a
few hafty remarks on a very beautiful Corona or
Halo which appeared this morning. I firft obferved
it about half after nine, though, I prefume, it made
its appearance much earlier : It then confided of a

bright

IO AN ACCOUNT OF THE

bright circle, of which the fun was the centre, form-
ed, as nearly as I could difcern, as is ufual with
large Coronas, of the feven primary colours, the
inner circumference being red, and the outer violet.
This appearance is not uncommon, though they fel-
dom appear as luminous as this : But this was accom-
panied by a phenomenon, which I cannot difcover to
have been mentioned by any writer on this fubjecl:,
which was a large white circle, which paffed through
the body of the fun.

About 1 1 o'clock I obferved them with Hadley's
quadrant, and found the diameter of the halo to be
about 440 ; that of the white circle about 6o° ; and
the altitude of the Sun 66°. The nodes or points
of interferon, continued horizontal during the
whole time. The appearance of it changed feveral
times during the morning ; fometimes both circles
would grow faint, and then again would become
vivid j at one time they both difappeared, but again
appeared in a few minutes more bright than ever j
until finally about one quarter after eleven, the white
circle vanifhed, and in 15 minutes more the halo dif-
appeared. All the morning, fmall, light clouds, from
the S. E.

July 25, 1796. T. S.

The

BILIOUS YELLOW FEVER IN 1797. II

The winter of 1797 was in general healthy.
During the fpring, which was cold and wet, no dif-
eafes of any confequence occurred. The fpring
vegetables were late in coming to maturity, and
there were every where in the neighbourhood of
Philadelphia fcanty crops of hay. In June and
July, there fell but little rain. Dy ferneries, chole-
ras, fcarlitina, and mumps, appeared in the fub-
urbs in the latter month. On the 8th of July I
vifited Mr. Friik, and on the 25th of the fame
month I vifited Mr. Charles Burrel in the yellow
fever in confultation with Dr. Phyfick. They both
recovered by the plentiful ufe of depleting reme-
dies.

The weather from the 2d to the 9th of Augufl
was rainy. On the ift of this month I was called
to vifit Mr. Nathaniel Lewis in a violent bilious fe-
ver. On the 3d I vifited Mr. Eliflia Hall with the
fame difeafe. He had been ill feveral days before
I faw him. Both thefe gentlemen died on the 6th
of the month. They were both very yellow after
death. Mr. Hall had a black vomiting on the day
he died.

The news of the death of thefe two citizens,
with unequivocal fymptoms of yellow fever, excited
a general alarm in the city. Attempts were made

12 AN ACCOUNT OF THE

to trace it to importation, but a little inveftigation
foon proved that it was derived from the foul air of
a fhip which had juft arrived from Marfeilles, and
which difcharged her cargo at Pine flreet wharf,
near the flores occupied by Mr. Lewis and Mr.
Hall. Many other perfons about the fame time
wTere affected with the fever from the fame caufe,
in Water and Penn ftreets. About the middle of
the month, a fhip from Hamburgh communicated
the difeafe, by means of her foul air, to the village
of Kenfmgton. It prevailed moreover in many in-
flances in the fuburbs, and in Kenfmgton from pu-
trid exhalations from gutters and marfhy grounds,
at a diftance from the Delaware, and from the foul
{hips which have been mentioned. Proofs of the
truth of each of thefe affertions ftiall be given in
their proper place.

The difeafe was confined chiefly to the diftricl of
Southwark and the village of Kenfmgton for fe-
veral weeks. In September and October many
cafes occurred in the city, but mofl of them were
eafily traced to the above fources.

The following account of the weather during
the months of Auguft, September and October
was obtained from Mr. Thomas Pryor. It is diffe-
rent from the weather in 1793. It is of confe-

quence

BILIOUS YELLOW FEVER IN 1797. 13

quence to attend to this fa£t, inafmuch as it (hows
that an inflammatory conflitution of the atmofphere
can exift under different circumstances of the wea-
ther. It likewife accounts for the variety in the
fymptoms of the fever in different years and coun-
tries. Such is the influence of feafon and climate
upon the fymptoms of this fever, that it led Dr.
M'Kitterick to fuppofe that the yellow fever of
Charleflon, fo accurately defcribed by Dr. Lining
in the 2d volume of the Phyfical and Literary
EfTays of Edinburgh, was a different difeafe from
the yellow fever of the Well Indies. *

METEOROLOGICAL OBSERVATIONS,

MADE IN PHILADELPHIA,

AUGUST, 1797.

Thermo- Baro- WINDS and WEATHER.

meter. met.r.

1 73 to 75 30 o S. E. E. Rain in the forenoon and

afternoon.

2 72 to 76 30 o N. E. by E. Cloudy with rain in the

afternoon and night. Wind E. by N.

3 72 to 78 30 6 E. \ N. Rain in the morning, and

all day and night.
4721078 30 4 E. Rained hard all day and at night.

* De febre Indiae Occidentalis maligna flava, p. 12.

14 AN ACCOUNT OF THE

Therm. Baro. WINDS and WEATHER.

5 74 to 79 29 84 Wind light — S. W. Cloudy. Rain

this morning. The air extremely

damp; wind fhifted to N. W. This

evening heavy fhowers, with thunder.

W. N. W. Cloudy.

N. W. Clofe day. Rain in the even-
ing and all night. Wind to E.

E. Rain this morning.

S. W. Cloudy morning.

N. W. Clear.

N. W. Clear. Rain all night.

S. W. Cloudy. Rain in the morn-
ing— Cloudy all day. — Rain at
night.

S. W. Cloudy. Rain all day.

N. W. Clear fine morning.

N. W. Air damp.

S. W. Cloudy. Rain, with thunder at
night — a fine fhower.
19 72 to 78 29 7 N. W. Clear. Cloudy in the even-
ing, with thunder.

W. N. W. Fine clear morning.

N. W. Clear to E.

E. Small ftiower this morning.

Hard ftiower at 11, A. M. Wind
N. E.

E. Cloudy. At noon calm.

Calm morning and clear.

N. E. Clear. Rain in the afternoon,
with thunder.

6 73 to 76

3086

7 70 to 76

30 4

8 72 to 76

2995

9 72 to 76

29 86

10 69 to 73

30 16

11 70 to 734

3025

12 71 to 74

3° 5

13 73 to 75

2987

14 70 to 74

29 9

15 56 to 60

30 J5

16 60 to 64

30 24

17 60 to 65

30 24

18 68 to 75

3° 4

20 70 to 77

29 8

21 74 to 76

29 9

22 68 to 76

23 71 to 76

29 92

24 71 to 75

2995

25 70 to 75

30 5

BILIOUS YELLOW FEVER IN 1797.

Therm.

Baro.

WINDS and WEATHER.

26 70 to 75

30 5

S. E. Rain in the morning. Rained
hard in the night, -with thunder
N. W.

27 68 to 76

29 9

N. W. Fine clear morning.

28 64 to 75

29 96

N. W. Clear.

29 59 to 70

30 0

E. Clear.

30 70 to 76

30 1

E. by S. Rain in the morning.

31 68 to 74

30 H

S. E. Cloudy. Damp air and fultry.

SEPTEMBER, 1797.

Thermo- Baro-
meter meter.

1 73 to 80 30 6

2 79 to 80 29 9

3 68 to 74 30 o

4 66 to 74 30 7

5 58 to 724 30 1

6 58 to 72 30 13

7 $6 to 76 30 28

8 54 to 6$ 30 1

9 56 to 6$ 30 1
10 58 to 6^ 30 26

WINDS and WEATHER.

S. W. Cloudy. Damp air. Rain
in the morning.

N. W. Clear. Cloudy in the even-
ing, with lightning to the fouthward.

N. by W. Cloudy. Clear in the af-
ternoon and night.

W. N. W. Clear fine morning.

N. W. Clear. Cloudy in the evening.

Frefh at E. Clear. Rain in the even-
ing.

E. Clear. Cloudy in the evening.

N. E. Clear and cool morning

Flying clouds at noon.

E. N. E. Clear.

N. E. Clear fine morning. Wind
frefh at N. E. all xday.

l6 AN ACCOUNT OF THE

Therm.

Baro.

WINDS and WEATHER.

ii 53 to 64

3° J3

N. to E. with flying clouds.

12 51 to 62

30 6

W. N. W. Clear cool morning.

13 56 to 67

30 3

S. W. Cloudy. Clear in the afternoon.

14 64 to 70

29 98

S. W. Clear.

15 66 to 73

2985

S. W. Rain in the morning. Cloudy
in the afternoon.

16 62 to 70

2995

N. W. Clear.

17 56 to 67

30 0

N.W. Clear.

18 58 to 6$

29 88 to E. Cloudy. Rained all day, and thun-

29 62

der. Rained very heavy at night.

19 55 to 63

29 15

W. N. W. Clear fine morning.

20 47 to 6$

30 8

W. N. W. Clear fine morning. D
Moon at 9 50 morning.

21 46 to 60

30 0

N. E. Clear fine morning; — to S. E.
in the evening. Cloudy at night.

22 56 to 6$

3° 4

N. W. Rain in the morning. Rain
at night.

23 56 to 66

30 0

N. N. E. Cloudy.

24 52 to 66

29 9 to E. by S. Clear fine morning. Clou-

29 7S

dy at night.

25 56 to 68

29 37

W. N. W. Clear fine morning — clear
all day.

26 58 to 68

29 95

E. In the morning flying clouds.

27 48 to 63

30 2

N. W. Clear fine morning — clear all
day.

28 54 to 63

30 2

W. N. W. Clear fine morning — clear
all day.

29 54 to 63

30 *5

E. Clear fine morning.

30 60 to 65

30 26

E. Frefh. Cloudy morning. Rain
in the night.

OCTOBER,

BILIOUS YELLOW FEVER IN 1797. 17

OCTOBER, 1797.

Thermo- Baro- WINDS and WEATHER,

meter. meter.

1 55 to 65 30 16 N. E. Rain this morning and great

part of the day.

2 55 to 66 30 o N. W. Clear.

3 to to 70 29 9 S. E. Clear. Air damp.

4 60 to 70 29 5 W. N. W. Rain this morning.

5 46 to 60 30 o W. N. W. to S. by W. in the evening.

Clear all day. White froft this
morning.

6 55 to 65 30 o S. W. Clear fine morning. White

froft.

7 56 to 76 10 o S. W. Cloudy. Rain in the night.

8 56 to 70 3029 S. Cloudy this morning — air damp.

Wind ihifted to W. N. W. Blows
frefh.

9 50 to 60 29 85 W. N. W. Clear morning. Frefh at

N. W. in the evening.
W. N. W. Clear. Froft this morning.
W. N. W. Cloudy.
W. N. W. Clear. Ice this morning.
N. Clear fine morning. Ice this

morning.
N. E. Cloudy.
W. N. W. Clear.
W. N. W. Clear fine morning.
W. N. W. Clear fine morning.
W. N. W. Clear fine weather.
N. W. Clear fine day.

C ?Q

10 4c to 58

3° 1

11 38 to 56

30 2

12 34 tO 52

30 3*

*3 35 t0 55

30 5

14 40 to 60

30 28

15 50 to 65

30 16

16 36 to 56

30 2

17 37 to 56

30 18

18 47 to 60

29 86

19 48 to 60

30 6

Io AN ACCOUNT OF THE

Therm. Baro. WINDS and WEATHER.

20 42 to 55 30 8 N. E. Cloudy. Rain in the afternoon

and night. Blows frefli at N. E.

21 42 to 50 29 92 N. E. Blows frefli, (with a little

rain.) — Thunder in the night, with
rain.

22 44 to 56 2957 N. W. Rain in the morning.

23 44 to 56 29 95 S. W. Clear fine morning.
24421054 30 5 N. E. Cloudy. A great deal of rain

in the night.
25 40 to 52 30 15 N. E. Clear fine morning.
16 36 to 48 30 29 W. N. W. Clear.

27 34 to 46 30 23 Frefh at S. W. Clear.

28 40 to 52 29 95 W. N. W. Cloudy.

29 34 to 46 29 82 W. Cloudy.

30 32 to 42 29 93 N. W. Clear. Hard trod this morning.

31 38 to 48 30 18 W. S. W. Cloudy part of this day;

clear the remainder.

In addition to the regifter of the weather, it may
not be improper to add, that mufquetoes were more
numerous during the prevalence of the fever than
in 1793. An unufual number of ants and cock-
roaches were likewife obferved ; and it was faid
that the martins and fwallows difappeared for a
while, from the city and its neighbourhood.

A difeafe prevailed among the cats fame weeks
before the yellow fever appeared in the city. It

excited

BILIOUS YELLOW FEVER IN 179?. 19

excited a belief in an unwholefome ftate of the at-
mofphere, and apprehenfions of a fickly fall. It
was generally fatal.

After the firft week in September, there were
no difeafes to be feen but yellow fever. In that
part of the town which is between Walnut and
Vine ftreets it was uncommonly healthy. A fimi-
lar retreat of inferior difeafes has been obferved
to take place during the prevalence of the plague in
London, Holland, and Germany, according to the
hiftories of that difeafe by Sydenham, Diemer-
broek, Sennertus and Hildanus. It appears from
the regifter of the weather, that it rained during
the greatest part of the day on the ifl of October.
The effects of this rain upon the difeafe mall be
mentioned hereafter. On the ioth the weather
became cool, and on the nights of the 12th and
13th of the month, there was a frofl accompanied
with ice, which appeared to give a fudden and com-
plete check to the difeafe. *

* It has been fuppofed that the yellow fever is checked
only by heavy rains and froft. Dr. Irvine lately informed
me, that the cafes of it were always leifened in Charleiton in
the year 1796 when the wind came from the call or fouth eafl;,
and that they revived when it blew from the weft or fouth
weft.

C 2 The

CLO AN ACCOUNT OF THE

The reader will probably expert an account of the
effects of this diflreffmg epidemic upon the public
mind. — The terror of the citizens for a while was
very great. Rumors of an oppofite and contradictory
nature of the increafe and mortality of the fever
were in conflant circulation. A floppage was put
to bufmefs, and it was computed that about two-
thirds of the inhabitants left the city.

The legiflature of the ftate early pafTed a law-
granting 10,000 dollars for the relief of the fufFer-
ers by the fever. The citizens in and out of town,
as alfo many of the citizens of our filler flates,
contributed more than that fum for the fame cha-
ritable purpofe. This money was ilfued by a com-
mittee appointed by the governor of the flate. A
hofpital for the reception of the poor was eflablifh-
ed on the eafl fide of the river Schuylkill, and
amply provided with every thing neceffary for the
accommodation of the fick. Tents were likewife
pitched on the eafl fide of Schuylkill, to which all
thofe people were invited who were expofed to the
danger of taking the difeafe, and who had not
means to provide a more comfortable retreat for
themfelves in the country.

I am forry to add, that the moral effecls of the
fever upon the minds of our citizens were confined

chiefly

BILIOUS YELLOW FEVER IN IJQJ. 21

chiefly to thefe acts of benevolence. Many of the
publications in the newfpapers upon its exiflence,
mode of cure and origin, partook of a virulent
fpirit which illy accorded with the diftreiTes of the
city. It was a caufe of lamentation likewife to
many ferious people, that the citizens in general
were lefs difpofed than in 1793, to acknowledge
the agency of a divine hand in their afflictions. In
fome, a levity of mind appeared upon this folemn
occafion. A worthy bookfeller gave me a melan-
choly proof of this aflertion, by informing me,
that he had never been afked for playing cards fo
often in the fame time, as he had been during the
prevalence of the fever.

Philadelphia was not the only place in the Unit-
ed States which fuffered by the yellow ftvew It
prevailed at the fame time at Providence in Rhode
Ifland, at Norfolk in Virginia, at Baltimore, and in
many of the country towns of New England, New
Jerfey, and Pennfylvania.

The influenza followed the yellow fever as it did
in the year 1793. It made its appearence in the
latter end of October, and affected chiefly thofe
citizens who had been out of town.

The

1$ AN ACCOUNT OF THE

The weather became feverely cold about the
middle of November, and continued fo during the
greateft part of the winter. The navigation of the
Delaware was completely obftructed on the 5th of
December. Cafes of bilious pleurify and of the
hydrocephalic ftate of fever, were common in all
the winter months. They yielded in every inftance
which came under my care, to copious depletion by
the lancet, and mercury.

In the months of February and March, a ca-
tarrhal fever, attended in fome instances with fymp-
toms of cynanche trachealis, prevailed among chil-
dren. It was cured by gentle pukes, purges of
calomel and blood-letting. I bled a child of Mr.
PiiTo, of fix weeks old, twice, and a child of Mr.
Bi'lington, of three weeks old, once in this fever,
and thereby I believe faved their lives.

The predifpofmg caufes of the yellow fever in
the year 1797 were the fame as in the year 1793.
Strangers were as ufual moil fubjeel: to it. The
heat of the body in fuch perfons in the Weft In-
dies has been found to be between three and four
degrees above that of the temperature of the na-
tives. This fa& is taken notice of by Dr. M'Kit-
terick, and to this he afcribes, in part, the predif-
pofition of new comers to the yellow fever.

BILIOUS YELLOW FEVER IN 1797. 2$

In addition to the common exciting caufes of
this difeafe formerly enumerated, I have only to add,
that it was induced in one of my patients byfmoak-
ing a fegar. He had not been accuftomed to the
ufe of tobacco.

I faw no new premonitory fymptoms of this fever
except a tooth-ach. It occurred in Dr. Phyfick,
Dr. Caldwell, and in Mr. Bellenger, one of my
pupils. In Mifs Elliot there was fuch a forenefs in
her teeth, that ilie could hardly clofe her mouth on
the day in which fhe was attacked by the fever.
Neither of thefe perfons had taken mercury to ob-
viate the difeafe.

I fhall now deliver a fliort account of the fymp-
toms of the yellow fever, as they appeared in feve-
ral of the different fyftems of the body.

I. There was but little difference in the (late
of the pulfe in this epidemic from what has been
recorded in the fevers of 1793 and 1794. I per-
ceived a pulfe in feveral cafes which felt like a foft
quill which had been /battered by being trodden
upon. It occurred in Dr. Jones and Dr. Dobell,
and in feveral other perfons who had been worn
down by great fatigue, and it was in every inflance,
followed by a fatal iflue of the fever. In Dr. Jones

this

24 AN ACCOUNT OF THE

this ftate of the pulfe was accompanied with fuch a
difficulty of breathing, that every breath he drew
on the day of his attack, he informed me, was the
effort of a figh. He died on the 17th of Septem-
ber, and on the fixth day of his fever*

The action of the arteries was as ufual very irre-
gular in many cafes. In fome there was a diftreff-
ing throbbing of the veffels in the brain, and in one
of my patients a fimilar fenfation in the bowels, but
without pain. — Many people had iffues of blood
from their blifters in this fever.

I faw nothing new in the effects of the fever
upon the liver, lungs, brain, nor upon the ftomach
and bowels.

II. The excretions were diftinguiflied by no un-
ufual marks. I met with no recoveries where there
were not black flools. They excoriated the reftum
in Dr. Way. It was a happy circumftance where
morbid bilious matter came away in the beginning
of the diforder. But it frequently refilled the
mofl powerful cathartics until the 5th or 7th day of
the fever, at which time it appeared rather to yield
to the diforganization of the liver than to medi-
cine. Where fufficient blood-letting had been pre-
vioufly ufed, the patient frequently recovered, even

after

BILIOUS YELLOW FEVER IN 1 797. 25

after the black difcharges from the bowels took
place in a late ftage of the difeafe.

Dr. Coxe informed me that he attended a child
of feventeen months old which had white ftools
for feveral days. Towards the dole of its difeafe,
it had black ftools, and foon afterwards died.

Dr. Stewart ventured to tafte the black matter
which was difcharged from the ftomach jufl before
death in two inftances. In both cafes it bliftered
his tongue.

Several of my patients difcharged worms during
the fever. In one inflance they were difcharged
from the mouth.

A preternatural frequency in making pale water
attended the firft attack of the difeafe in Mr. Jo-
feph Fifher.

A difcharge of an unufual quantity of urine
preceded, a few hours, the death of the daughter
of Mrs. Read.

In two of my patients there was a total fuppref-
fion of urine. In one of them it continued five
days without exciting any pain.

There

i6 AN ACCOUNT or THE

There was no difpoiition to fweat after the firft
and fecond days of the fever. Even in thofe flares
of the fever in which the intermiiTions were mod
complete, there was fel dom any moifturc or even
foftnefs on the fkin. This was fo characteriftic of
malignity in the bilious fever, that where I found
the oppofite date of the fkin towards the clofe of a
paroxyfm, I did not hefitate to encourage my pa-
tient, by alluring him that his- fever was of a mild
nature, and would molt probably be fafe in its hTue.

III. I faw no unufual marks of the difeafe in the
nervous fyftem. The mind was feldom affected by
delirium after the lofs of blood. There was a dif-
pofition to ihed tears in two of my patients. One
of them wrept during the whole time of a paroxyfm
of the fever. In one cafe I obferved an uncommon
dulnefs of apprehenfion, with no other mark of a
difeafed flate of the mind. It was in a man whofe
faculties in ordinary health, acted with celerity and
vigor.

Dr. Caldwell informed me of a lingular change
which took place in the operations of his mind
during his recovery from the fever. His imagina-
tion carried him to an early period of his life, and
engaged him for a day or two in playing with a bow
and arrow, and in amufements of which he had

been

BILIOUS YELLOW FEVER IN 1797. 1J

been fond when a boy. A fimilar change occurred
in the mind of my former pupil Dr. Fifher, during
his convalefcence from the yellow fever in 1793.
He amufed himfelf for two days in looking over
the pictures of a family Bible which lay in his room,
and declared that he found the fame kind of plea-
fure in this employment that he did when a child.
However uninterefting thefe facts may now appear,
the time will come, when they may probably fur-
nifh ufeful hints for completing the phyfiology,
and pathology of the mind.

Where blood-letting had not been ufed, patients
frequently died of convulfions.

IV. The fenfes of feeing and feeling were impair-
ed in feveral cafes. Mrs. Bradford's vifion was fo
weak that fhe hardly knew her friends at her bed-
fide. I had great pleafure in obferving this alarm-
ing fyrnptom fuddenly yield to the lofs of four
ounces of blood.

Several perfons who died of this fever, did not
from the beginning to the end of the difeafe feel
any pain. I {hall hereafter endeavour to explain
the caufe of this infenfible ftate of the nerves.

The

2 3 AN ACCOUNT OF THE

The appetite for food was unimpaired for three
days in Mr. Andrew Brown, at a time when his
pulfe indicated a high grade of the fever. I heard
of feveral perfons who ate with avidity jufl before
they died.

V. Glandular fwellings were very uncommon in
this fever. I fhould have afcribed their abfence to
the copious ufe of depleting remedies in my prac-
tice, had I not been informed that morbid affections
of the lymphatic glands were unknown in the city
hofpital where blood-letting was feldom ufed, and
where the patients in many inflances died before
they had time to take medicine of any kind.

VI. The /kin was cool, dry, fmooth, and even
Alining in fome cafes. Yellownefs was not univerfal.
Thofe fmall red fpots which have been compared to
mufqueto bites, occurred in feveral of my patients.
Dr. John Duffield, who acted as houfe furgeon
emd apothecary at the city hofpital, informed me
that he faw vibices on the ikin in many cafes, and
that they were all more or lefs fore to the touch.

VII. The blood was diffolved in a few cafes. That
appearance of the blood which has been compared
to the warnings of fiefh, was very common. It
was more or lefs fizy towards the clofe of the dif-

eafe

BILIOUS YELLOW FEVER IN 1797. 29

cafe in moft cafes. I have fufpe&ed, from this cir-
cumftance, that this mark of ordinary morbid ac-
tion, or inflammation, was in part the effect of the
mercury acting upon the blood-velfeJs. It is well
known that fizy blood generally accompanies a fali-
vation. If this conjecture be well founded, it will
not militate againfl the ufe of mercury in malignant
fevers, for it fhews that this valuable medicine pof-
feffes a power of changing an extraordinary and
dangerous degree of morbid action in the blood-
veffels, to that which is more common and fafe. I
have feldom feen a yellow fever terminate fatally-
after the appearance of fizy blood.

Dr. Stewart informed me that in thofe cafes in
which the ferum of the blood had a yellow colour,
it imparted a faline tafte only to his tongue. He
was the more ftruck with this fact, as he perceived
a flrong bitter ftate upon his /kin in a fevere at-
tack of the yellow fever in 1793.

I proceed next to take notice of the type of the
fever.

In many cafes it appeared in the form of a remit-
ting and intermitting fever. The quotidian and
tertian forms were moft common. In Mr. Robert
Wharton it appeared in the form of a quartan.

But

30 AN ACCOUNT OF THE

But it frequently affumed the character which is
given of the fame fever in Charlefton by Dr. Lin-
ing. It came on without chills, and continued with-
out any remiffion for three days ; after which the
patient believed himfelf to be well, and fometimes
rofe from his bed, and applied to bufinefs. On
the fourth or fifth day the fever returned, and un-
lefs copious evacuations had been ufed in the early
flage of the difeafe, it generally proved fatal.
Sometimes the powers of the fyftem were deprefled
below the return of active fever, and the patient
funk away by an eafy death without pain, heat, or
a quick pulfe. I have been much puzzled to diftin-
guiih a crifis of the fever on the third or fourth day,
from the infidious appearance which has been de-
fcribed. It deceived me in 1793. It may be known
by a preternatural coolnefs in the /kin, and languor
in the pulfe, by an inability to fit up long without
fatigue, or faintnefs, by a dull eye, and by great
depreflion of mind, or fuch a flow of fpirits as
fometimes to produce a declaration from the patient
that " he feels too well." Where fhefe fymp-
toms appear, the patient mould be informed of his
danger, and urged to the continuance of fuch re-
medies as are proper for him.

The following flates or forms were obfervable
in the fever :

1. la

BILIOUS YELLOW FEVER IN 1 797. Jf

i. In a few cafes the contagion or miafmata pro-
duced death in four and twenty hours with convulfi-
ons, coma, or apoplexy.

2. There were open cafes in which the pulfe was
full and tenfe as in a pleurify or rheumatifm from the
beginning to the end of the fever. They were ge-
nerally attended with a good deal of pain.

3. There were depreffed or locked cafes, in
which there were a fenfe of great debility, but
little or no pain, a depreffed and flow pulfe, a cool
fkin, cold hands and feet, and obftructed excretions.

4. There wrere divided or mixed cafes in which
the pulfe was active until the 4th day, after which
it became depreffed. All the other fymptoms of the
locked date of the fever accompanied this depreffed
ftatc of the pulfe.

5. There were cafes in which the pulfe imparted
a perception like that of a foft and shattered quill.
I have before mentioned that this ftate of the pulfe
occurred in Dr. Jones and Dr. Dobell. I felt it but
once and on the day of his attack in the latter
gentleman, and expreffed my opinion of his ex-
treme danger to my fon upon my return from

viiitine

$2 AN ACCOUNT OF THE

vifiting him. I did not meet with a cafe which termi-
nated favourably, where I perceived this shatter-
ed pulfe. A difpofition to fweat occurred in this flatc
of the fever.

6. There were what Dr. Caldwell happily called
walking cafes. The patients here were flufliedor
pale, had a full or tenfe pulfe, but complained of no
pain, had a good appetite, and walked about their
rooms or houfes as if they were but little indifpofed
until a day or two, and in fome inftances, until a
few hours before they died. The impreffion of the
remote caufe of the fever in thefe cafes was beyond
fenfation, for upon removing a part of it by bleeding
or purging, the patients complained of pain, and
the excitement of the mufcles paiTed fo completely in-
to the blood-veflels and alimentary canal, as to con-
vert the fever into a common and more natural form.
Thefe cafes were always dangerous, and when ne-
gle&ed, generally terminated in death. Mr. Brown's
fever came on in this infidious fhape. It was cured
by the lofs of upwards of an ioo ounces of blood,
and a plentiful falivation.

7. There was the intermitting form in this
fever. This, like the laft, often deceived the patient
by leading him to fuppofe his difeafe was of a com-
mon or trifling nature. It prevented Mr. Richard

Smith

BILIOUS YELLOW FEVER IN 1797. 33

Smith from applying for medical aid in an attack of
the fever for feveral days, by which means it made
fuch an impreiTion upon his vifcera, that depleting re-
medies were in vain ufed to cure him. He died in the
prime of life, beloved and lamented by a numerous
circle of relations and friends.

8. There was a form of this fever in which it re-
fembled the mild remittent of common feafons. It
was diflinguilhed from it chiefly by the black colour
of the inteflinal evacuations.

9. There were cafes of this fever fo light, that
patients were faid to be neither Jick, nor well: or
in other words, they were fick and well, half a do-
zen times in a day. Such perfons walked about, and
tranfa&ed their ordinary bufmefs, but complained of
dulnefs, and occafionally, of {hooting pains in their
heads. Sometimes the flomach was affected with
ficknefs, and the bowels with diarrhoea or cof-
tivenefs. All of them complained of night fweats.
The pulfe was quicker than natural, but feldom had
that convulfive action which conftitutes fever. Pur-
ges always brought away black (tools from fuch pa-
tients, and this circumftance ferved to eftablifh its
relationfhip to the prevailing epidemic. Now and
then by neglect, or improper treatment, it affumed
a higher and more dangerous grade of the fever, and

D became

34 AN ACCOUNT OF THS

became fatal, but it more commonly yielded to na-
ture, or to a fingle dofe of purging phyfic.

10. There were a few cafes in which the fkin was
affected with univerfal yellownefs, but without more
pain or indifpofition than ufually occurs in the jaun-
dice. They were very frequent in the year 1793*
and generally prevail in the autumn, in all places
fubjecl: to bilious fever,

11. There were chronic cafes of this fever. It
is from the want of obfervation that phyficians limit
the duration of the yellow fever to certain days. I have
feen many inflances in which it has been protracted
into what is called by authors a flow nervous fever.
The wife of captain Peter Bell died of a black vomit-
ing after an illnefs of nearly one month. Dr. Pinck-
ard formerly one of the phyficians of the Britifli
army in the Weft Indies, in a late vifit to this city
informed me, that he had often feen the yellow fever
put on a chronic form in the Weft India Iflands.

In delivering this detail of the various forms of the
yellow fever, I am aware that I oppofe the opinions
of many of my medical brethren who afcribe to it, a
certain uniform chara&er which is removed beyond
the influence of climate, habit, predifpofition, and
the different ftrength and combinations of remote and

exciting

BILIOUS YELLOW FEVER IN T797. 35

exciting caufes. — This uniformity in the fymptoms
of this fever is faid to exift in the Weft Indies, and
every deviation from it in the United States is called
by another name. The following communication
which I received from Dr. Pinkard will fhew that
this difeafe is as different in its forms in the Weft
Indies, as it is in this country.

" The yellow fever, as it appeared, among the
" troops, in Guiana, and the Weft India Iflands,
" in the years 1796, and 1797, exhibited fuch
" perpetual inftability, and varied fo incefTantly in
" its character, that I could not difcover any one
" fymptom to be, decidedly diagnoftic ; and, hence,
" I have been led into an opinion that the yellow
" fever, fo called, is not a diftincl:, or fpecific,
*' difeafe, but, merely, an aggravated degree of the
" common remittent or bilious fever of hot climates,
" rendered irregular in form, and augmented in
" malignity, from appearing in fubjecls unaccuf-
* tomed to the climate."

Philadelphia, January 12th, 1798.

Many other authorities equally refpectable with
Dr. Pinckard's, among whom are Pringle, Huck,
and Hunter, might be adduced in fupport of the
unity of bilious fever. But to multiply them fur-
ther, would be an act of homage to the weaknefs
D 2 of

36 AN ACCOUNT OF THS

of human reafon, and an acknowledgement of the
infant flate of our knowledge in medicine. As well
might we fuppofe nature to be an artift, and that
difeafes were fhaped by her like a piece of ftatuary,
or a fuit of clothes, by means of a chiffel, or pair
of fciffars, as admit every different form and grade
of morbid action in the fyfteiru to be a diftinct dif-
eafe.

Notwithftanding the fever put on the eleven
forms which have been defcribed, the moderate
cafes were few, compared with thofe of a malignant
and dangerous nature. It was upon this account
that the mortality was greater in the fame number
of patients, who were treated with the fame reme-
dies, than it was in the years 1793 and 1794.
The difeafe moreover partook of a more malignant
character than the two epidemics that have been
mentioned. The yellow fever in Norfolk, Drs.
Taylor and Hansford informed me in a letter I re-
ceived from them, was much more malignant and
fatal under equal circumflances than it was in 1795.

During the prevalence of the fever I attended the
following perfons who had been affected by the epi-
demic of 1793 — viz. Dr. Phyfick, Thomas Learning,
Thomas Canby, Samuel Bradford, and George
Loxley, alfo Mrs. Eggar who had a violent attack

BILIOUS YELLOW FEVER IN 1797. $J

of it in the year 1794. Samuel Bradford was
likewife affected by it in 1794.

There are two opinions which verge to equal ex-
tremes upon the fubjecl: of the contagious nature of
the yellow fever. While mod of the Weft India
phyficians deny its contagious quality altogether,
many American phyficians act as if they believed it
could be communicated by the deck of a fhip, af-
ter me has performed a voyage from a tropical
country. In a Weft India climate where the accu-
mulation of the effluvia from fick people is prevent-
ed by open doors and windows, it is eafy to conceive
this fever cannot be often propagated by contagion.
Even in our own country it has rarely been obferv-
ed to be contagious, in the months of July and
Auguft. But after cool weather renders it necefla-
ry to exclude the frefti air from fick rooms, it is
as eafy to conceive the fame effluvia may be fo ac-
cumulated, and concentrated, as to produce the dif-
eafe in other people. In this way it was propagated
in fome inftances during the year 1797, but by no
means fo often as in 1793 under equal circumftan-
ces. The reafon of this difference in the contagi-
ous nature of this fever in thofe two years muft be
fought for in the difference of the fenftble qualities
of the atmofphere.

During

38 AN ACCOUNT OF THE

During my intercourfe with the fick, I felt the
contagion of the fever operate upon my fyftem in
the mofl fenfible manner. It produced languor, a
pain in my head, and ficknefs at my ftomach. A
fighing attended me occafionally for upwards of two
weeks. This fymptom left me fuddenly, and was
fucceeded by a hoarfenefs, and at times, with
fuch a feeblenefs in my voice as to make fpeaking
painful to me. Having obferved this affection of
the trachea, to be a precurfor of the fever in feve-
ral cafes, it kept me under daily apprehenfions of
being confined by it. It gradually went off after
the 1 ft of October. I afcribed my recovery from
it, and a fudden diminution of the effects of the
contagion upon my fyftem, to a change produced
in the atmofphere by the rain which fell on that
day.

The contagion a&ed in a peculiar manner upon
Dr. Dobell. It induced a fneezing every time he
went into a fick room.

The gutters emitted in many places, a fulphuri-
ous fmell during the prevalence of the fever. Up-
on rubbing my hands together I could at any time
excite a fimilar fmell in them. I have taken notice
of this effect of the matters which produced the dif-
eafe, upon the body, in the year 1 794.

BILIOUS YELLOW FEVER IN 1797. 39

In order to prevent an attack of the fever, I care-
fully avoided all its exciting caufes. I reduced my
diet, and lived fparingly upon tea, coffee, milk, and
the common fruits and garden vegetables of the fea-
fon, with a fmall quantity of falted meat, and fmoked
herring. My drinks were milk and water, weak claret
and water, and weak porter and water. I metered my-
felf as much as poflible from the rays of the fun, and
from the action of the evening air, and accommo-
dated my drefs to the changes in the temperature
of the atmofphere. By fimilar means, I have rea-
fon to believe, many hundred people efcaped the
difeafe who were conftantly expofed to it. There
appears to be no combination of climate and miaf-
mata that can refill the good effects of abftinence
or depleting medicines in preventing, or moderating
an attack of this fever. Of this Dr. Borland of
the Britifh military hofpitals in the Weft Indies has
lately furnifhed me with the following proof. " In
" the beginning of Augufl 1797 (fays the Doctor
<c in a report which he politely put into my hands)
u 109 Dutch artillery arrived at Port-au-Prince in
" the Bangalore tranfport. The florid appearance
Cf of the men, their heavy cumberfome cloathing,
" and the feafon of the year, feemed all unfavour-
" able omens of the melancholy fate we prefumed
" awaited them. It was however thought a favour-
" able opportunity by Dr. Jackfon and myfelf to

" try

40 AN ACCOUNT OF THE

" try what could be done in warding off the fever.
" It was accordingly fuggefled to Monfieur Con-
" turier the chief furgeon of the foreign troops,
" and the furgeon of the regiment, that the whole
" detachment fhould be blooded freely, and that the
" morning after a dofe of phytic fhould be admini-
" flered to every man. This was implicitly complied
" with in a day or two after, and at this moment in
" which I write, ^although a period of four months
" has elapfed, but two of that detachment have died,
" one of whom was in a dangerous date when he
" landed. A fuccefs unparalleled during the war in
" St. Domingo ! It is true feveral have been attack-
" ed with the difeafe, but in thofe, the fymptoms
" were lefs violent, and readily fubfided by the early
w ufe of the lancet.

" The crew of the Bangalore on her arrival at
ce Port-au-Prince confuted of twenty eight men.
" With them no preventive plan was followed : in a
" very few weeks eight died, and at prefent, of the
" original number but fourteen remain."

I met with one inftance in which a light attack of
the fever was excited by the breath of a perfon who
was infected, but in whom the difeafe had not made
its appearance.

One

BILIOUS YELLOW FEVER IN 1797. 4!

One of my patients who was under a falivation
wafhed his mouth with milk, and difcharged it into a
bafon. Two cats licked up part of this milk. They
both fickened immediately, with the fymptoms of
fever. One of them died on the 4th and the other
on the 7th day afterwards.

The number of deaths by the fever in the months
of Augufl, September and October, amounted to be-
tween ten and eleven hundred. In the lift of
the dead were nine practitioners of phyfic, feveral
of whom were gentlemen of the mod refpeclable cha-
racters. This number will be thought confiderable
when it is added, that not more than three or four
and twenty phyficians attended patients in the dif-
eafe. . Of the furvivors of that number, eight were
affected with the fever. This extraordinary mortal-
ity andficknefs among the phyficians, muftbe afcrib-
ed to their uncommon fatigue in attending upon the
lick, and to their inability to command their time,
and labours, fo as to avoid the exciting caufes of
the fever. Among the medical gentlemen whofe
deaths have been mentioned, was my excellent
friend Dr. Nicholas Way. I fhall carry to my
grave an affectionate remembrance of him. We
paffed our youth together in the ftudy of ni
cine, and lived to the time of his death in the 1
bits of the tenderefl friendfnip. In the year 1

4- AN ACCOUNT OF THE

he removed from Wilmington, in the Delaware
ftate, to Philadelphia, where his talents and man-
ners foon introduced him into extenfive bufinefs.
His independent fortune furnifhed his friends with
arguments to advife him to retire from the city
upon the firft appearance of the fever. But his
humanity prevailed over the dictates of intereft,
and the love of life. He was active and intelligent
in fuggefting and executing plans to arreft the pro-
grefs of the difeafe, and to leffen the diftreffes of
the poor. On the 27th of Auguft he was feized,
after a ride from the country in the evening air,
with a chilly fit and fever. I faw him the next day,
and advifed the ufual depleting remedies. He fub-
mitted to my prefcriptions with reluctance, and in a
fparing manner, from an opinion that his fever was
nothing but a common remittent. To enforce obe-
dience to my advice, I called upon Dr. Griffiths
to vifit him with me. Our combined exertions to
overcome his prejudices againfl our remedies were
ineffectual. At two o'clock in the afternoon, on
the fixth day of his difeafe, with an aching heart I
faw the fweat of death upon his forehead, and felt
his cold arm without a pulfe. He fpoke to me with
difficulty : upon my rifmg from his bed fide to leave
him, his eyes filled with tears, and his countenance
fpoke a language which I ftill feel, but am unable
to defcribe. I promifed to return in a fhort time,

with

BILIOUS YELLOW FEVER IN 1797. 43

with a view of attending the lafl fcene of his life.
Immediately after I left his room, he wept aloud.
I returned haftily to him, and found him in convul-
fions. He died a few hours afterwards. Had I
met with no other affliction in the autumn of 1797
than that which I experienced from this affecting
fcene, it would have been a fevere one, but it was
a part only of what I fuffered from the death of
other friends, from the malice of enemies, and from
the complicated diftrefles of my family. I beg the
reader's pardon for this digreflion. It mall be the
only time, and place, in which any notice mall be
taken of my forrows and perfecutions in the courfe
of this publication.

It remains now to mention the origin of the fe-
yer.

Soon after the citizens returned from the coun-
try, I rece ved the following letter from the gover-
nor of the ftate.

" Letter

44 AN ACCOUNT OF THE

<( Letter from Thomas Mifflin, Efq. Governor of
the State of Pennfylvania, to Dr. Benjamin-
Rush.

u Philadelphia, 6th November, 1797.
" Sir,

cc I am defirous to obtain, for the infor-
mation of the Legiflature, the moil correct account of
the origin, progrefs, and nature of the difeafe that
has recently afflicted the city of Philadelphia, with a
view that the moil efficacious fteps fhould be taken
to prevent a recurrence of fo dreadful a calamity.
I have requefted the opinion of the college of phy-
licians on the fubjecl: ; but, as I underftand that you
and many other learned members of the faculty do
not attend the deliberations of that inftitution, the
refult of my inquiries cannot be perfectly fatisfac-
tory without your co-operation and affiftance. Per-
mit me, therefore, Sir, to beg the favour of you,
and of fuch of your brethren as you fhall be pleafed
to confult, to ftate, in anfwer to this letter, the
opinion which your refearches and experience have
enabled you to form on the important object of the
prefent inveftigation.

I am refpectfully, Sir,
Your moil obedient
Humble fervant,
THOMAS MIFFLIN."
" Dr. Benjamin Rush."

BILIOUS YELLOW FEVER IN 1 797. 45

To this letter the following anfwer was fent,
fubfcribed by thirteen of the phyficians of the city.

" Sir,

" IN compliance with your requeft, the
fubfcribers have devoted themfelves to the invert le-
gation of the origin, progrefs, and nature of the
fever which lately prevailed in our city, and we
have now the honor of communicating to you the
refult of our inquiries and obfervations.

" We conceive the fever which has lately prevail-
ed in our city, commonly called the yellow fever, to
be the bilious remitting fever of warm climates ex-
cited to a higher degree of malignity by clrcuitt-
rtances to be mentioned hereafter.

" Our reafons for this opinion are as. follows z

cc I. The famenefs of their origin ; both being the
offspring of putrefaction. Of this there are many
proofs in the hiftories of the yellow fever in the
Weft Indies. Where there is no putrefaction, the
Weft India iflands enjoy a perfect exemption from
that difeafe in common with northern climates.

Ci II. The yellow fever makes its appearance in
thofe months chiefly in which- the bilious fever pre-
vails

4<5 AN ACCOUNT OF THE

vails in our country, and is uniformly checked and
deftroyed by the fame caufes, viz* heavy rains and

froils.

" III. The fymptoms of the bilious and yellow
fever are the fame in their nature. They differ
only in their degree. It is noobje&ion to this affer-
tion that there is fometimes a deficiency or abfencc
of bile in the yellow fever. This fymptom is the
effect only of a torpid ftate of the liver, produced
by the greater force of the difeafe acting upon that
part of the body. By means of depleting reme-
dies this torpor is removed and the difeafe thereby
made to affume its original and fimple bilious cha-
racter.

" IV. The common bilious and yellow fever often
run into each other. By depleting remedies the
mod malignant yellow fever may be changed into
a common bilious fever, and by tonic remedies, im-
properly applied, the common bilious fever may be
made to affume the fymptoms of the mofl malignant
yellow fever.

a V. The common bilious and yePow fevers
are alike contagious, under certain circumftances of
the weather and of predifpofition in the body.
That the common bilious fever is contagious, wc

affert

BILIOUS YELLOW FEVER IN 1797. 47

aflert from the obfervations of fome of us, and
from the authority of many phyficians, who have
long commanded the higheft refpect in medicine.

" VI. The yellow and mild bilious fevers mutu-
ally propagate each other. We conceive a belief in
the unity of thefe two ftates of fever, to be deeply in-
terefting to humanity, inafmuch as it may lead pa-
tients to an early application for medical aid, and
phyficians to the ufe of the fame remedies for each
of them, varying thofe remedies only according to
the force of the diforder. It is nu ubjc&ion to this
opinion, that that ftate of bilious fever called the
yellow fever, is a modern appearance in our coun-
try. From certain revolutions in the atmofphere
as yet obferved only, but not accounted for by phy-
ficians, difeafes have in all ages and countries alter-
nately rifen and fallen in their force and danger.
At prefent a conftitution of the atmofphere prevails
in the United States which difpofes to fevers of a
highly inflammatory character. It began in the
year 1793. Its duration in other countries has
been from one to fifty years. It is not peculiar to
the common bilious fever to have put on more in-
flammatory fymptoms than in former years. There
is fcarcely a difeafe which has not been affected in
a fimilar way by the late change in our atmofphere,
and that does not call for a greater force of deplet-
ing

4$ AN ACCOUNT OF THE

ing remedies than were required to cure them be-
fore the year 1793.

" VTL And Lastly. The yellow fever affects
the fyftem more than once, in common with the
bilious fever. Of this there were many inftances
during the prevalence of our late epidemic.

" The fever which lately prevailed in our city,
appears from the documents which accompany this
letter, to have been derived from the following
fources.

<c I. Putrid exhalations from the gutters, ffiree&j
ponds, and marlhy grounds in the neighbourhood
of the city. From fome one of thefe fources we
derive a cafe attended by Dr. Caldwell on the 9th
o*f June — one attended by Dr. Pafcalis on the 2 2d
July, and two cafes attended by Dr. Riifh and Dr.
Phyfick on the 5th and 15th of the fame month ;
and alfo moft of thofe cafes of yellow fever, which
appeared in the northern parts of the city, and near
Kenfington bridge, in the months of Augufl, Sep-
tember and October. We are the more fatisfied of
the truth of this fource of the fever, from the nu-
merous accounts we have received of the prevalence
of the fame fever, and from the fame caufes, dur-
ing the late autumn in New York, and in various

parts

BILIOUS YELLOW FEVER IN 1 797. 49

parts of New Jerfey, Pennfylvania, Maryland, Vir-
ginia, and South Carolina, not only in fea ports,
but inland towns. The peculiar difpofition of thefe
exhalations to -produce difeafe and death, was evin-
ced early in the feafon by the mortality which pre-
vailed among the cats, and during every part of
the feafon, by the mortality which prevailed in
many parts of our country among horfes. The
difeafe which proved fo fatal to the latter animals,
is known among the farmers by the name of the
Tellow Water. We conceive it to be a modifica-
tion of the yellow fever.

cc II. A fecond fource of our late fever appears to
have been derived from the noxious air emitted from
the hold of the fnow Navigation, capt. Linflroom,
which arrived with a healthy crew from Marfeilles
on the 25th of July, and difcharged her cargo at
Latimer's wharf after a paffage of eighty days.
We are led to afcribe the principal part of the dif-
eafe which prevailed in the fouth end of the city
to this noxious air, and that for the following rea-
fons :

" 1. The fever appeared firfl on board this veffei
and in its neighbourhood, affecling a great number
of perfons nearly at the fame time, and fo remote
from each other that it could not be propagated by

contagion*

There

50 A ^ACCOUNT OP TH2

1 tr^ft frjFQherc was in the hold of this veffel a quant!-
tf"&P ¥%etabj^ijfiatter55 fuch as prunes, almonds,
$r*u olives, .cstt^te^and feveral other articles, fome of
'ere 1a a itate of putrefa&ion.

cc 3. A moft offenfive fmell was emitted from this
veffel, after fhe had difcharged her cargo, which
was perceived by perfons leveral hundred feet from
the wharf where (lie was moored.

" 4. A fimilar fever has been produced from fimi-
!ar caufes, in a variety of inftances : we fhall brief-
ly mention a few of them.

c: At Tortofc, a fever was produced in the month
of June, in the year 17S7, on board the fhip Bri-
tannia, capt. James Welch, from the noxious air
generated from a few bufhels of potatoes, which
deftroyed the captain, mate, and mod of the crew,
in a few days.

" Two failors were affected with a malignant fe-
ver, on board the , capt. Thomas Egger, in the

month of March, 1797, from the noxious air pro-
duced by wine that had putrefied in the hold of the
fhip, one of whom died foon after her arrival at
Philadelphia.

" In the month of June, 1793, the yellow fever
was generated by the noxious air of fome rotted

bags

BILIOUS YELLOW FEVER IN 1797. 51

bags of pepper on board a French Indiaman, which
was carried into the port of Bridgetown, by the
Britifh letter of marque Pilgrim. All the white
men, and mofl: of the negroes employed in remov-
ing this pepper, perifhed with the yellow fever,
and the foul atmofphere affected the town, where
it proved fatal to many of the inhabitants.

cc On board the Bufbridge Indiaman, a yellow fe-
ver was produced in the month of May, 1792, on
her paffage from England to Madras, which affect-
ed above two hundred of the crew. It was fuppof-
cd to be derived from infection, but many circum-
flances concur to make it probable that it was de-
rived from noxious air. The abfence of fmell in
the air does not militate againft: this opinion, for
there are many proofs of the mod malignant fe-
vers being brought on by airs which produced no
impreffion on the fenfe of fmelling. This is more
frequently the cafe when the impure air has paffed a
considerable diftance from its fource, and becomes
diluted with the purer air of the atmofphere.

" Several cafes are related by Dr. Lind, in his
treatife upon Fever and Infection of the Yellow
Fever, originating at fea under circumftances which
forbade the fufpicion of infection, and which can
only be afcribed to the impure air generated from
putrid vegetables,

E.3 " So

AN ACCOUNT OF THS

So well known, and fo generally admitted is
this fource of yellow fever in warm climates, that Dr.
Shannon, a late writer upon the means of prevent-
ing the difeafes of warm climates, in enumerating
its various caufes, exprefsly mentions " the putrid
" effluvia of a ihip's hold."

" We wifti due attention to be paid to thefe facts,
not only becaufe they lead to the certain means of
preventing one of the fources of this fever, but
becaufe they explain the reafons, why failors are fo
often its firit victims, and why from this circum-
fiance the origin of the difeafe has been fo haftily,
but erroneouily, afcribed folely to importation.

" The fever which prevailed along the fhore of
the Delaware, in Kenfmgton, and which proved fatal
to Mr. Jofeph Bowers and two of his family, wc
believe originated from the noxious air emitted from
the hold of the fhip Huldah, capt. Wm. Warner.
This air was generated by the putrefaction of cof-
fee, which had remained there during her voyage
from Philadelphia to Hamburgh, and back again. *

" In the courfe of our inquiries, we were led to
fufpect. one fource of our late fever, to be of foreign
origin. The fails of the armed fhip Hinde, on

board

** Sec Appendix, letter A.

SILIOUS YELLOW F£Y£Jt IN 1797. $$

board of which feveral perfons had died of the yel-
low fever, on her paffage from Port-au-Prince, and
which arrived on the 4th of Augufl, were fent to
the fail ftore of Mr. Moyfe. Four perfons belong-
ing to the loft were foon afterwards affected with
fymptoms of a bilious yellow fever. We mail not
decide pofitively upon the origin of the fever in thefe
cafes •> but the following facts render it probable
that it was not derived from the perfons who had
died of it on board the fufpefted veiTel.

" 1. The fails emitted an offenfive fmell ; 2.
three of the cafes of the perfons affected fn the fail
loft were of a mild grade of the fever ; 3. the fever
was not propagated by contagion from any one of
them ; 4. the fail loft was within the influence of
the noxious air, which was emitted from the hold
of the fnow Navigation, being not more than fifty
yards, and was in the direction of the wind which
blew at that time over her. The extent of this
air has not been accurately afcertained^ but many
analogies gave us reafon to believe lhat it may be
conveyed by the wind, in its deleterious Rate, from
half a mile, to a mile.

" In fupport of the opinion we have delivered cf
the origin of our late fever, we mud add further,
that in that part of the city which lies between

Walnut

54 AN ACCOUNT OF THE

Walnut and Vine fbreets, and which appeared to be
free from the effects of exhalation and the noxious
air of the mips, there were but few cafes of the
fever which appeared to fpread by contagion, even
under the moil favourable circumftances for that
purpofe.

<f Having pointed out the nature and origin of
our late fever, we hope we fhall be excufed in men-
tioning the means of preventing it in future. Thefe
are,

" First, A continuance of the prefent laws for
preventing the importation of the difeafe from the
Weft Indies, and other parts of the world where
it ufually prevails.

" Secondly, Removing all thofe matters from
our flreets, gutters, cellars, gardens, yards, ftores,
vaults, ponds, &c. which by putrefaction in warm
weather afford the mod frequent remote caufe of
the difeafe, in this country. For this purpofe we
recommend the appointment of a certain number
of phyficians, whofe bufinefs it mail be to infpect
all fuch places in the city, the Northern Liberties
and Southwark, as contain any matters capable by
putrefaction of producing the difeafe, and to have
them removed,

" Thirdly,

BILIOUS YELLOW FLVER IN I Jij]:. 55

w; Thirdly, We earneftiy recommend the fre-
quent wa filing of all impure parts of the city in warm
and dry weather, by means of the pumps, until
the water of the Schuylkill can be made to wafli
all the fireets of the city ; a meafure which we
conceive promifes to our citizens the mod durable
exemption from bilious fevers of all kinds, cf do-
meftic origin.

" Fourthly, To guard againft: the frequent
fource of yellow fever from the noxious air of the
holds of fliips, we recommend the unlading all
fhips, with cargoes liable to putrefaction, at a di-
fiance from the city, during the months of June,
July, Aug lift, September and October. To pre-
vent the generation cf noxious air in the fliips, we
conceive every vefTel fliould be obliged by law to
carry and ufe a ventilator, and we recommend in
a particular manner the one lately contrived by Mr.
Benjamin Wynkoop. — We believe this invention
to be one of the moft important and ufeful, that has
been made in modern times, and that it is calcu-
lated to prevent not only the decay of mips
and cargoes, but a very frequent fource of pefti.
lential difeafes of all kinds^ in commercial cities.

" In thus deciding upon the nature and origin of
our late fever, we expect to adminifter confolation

$6 AN ACCOUNT OF THE

to our fellow citizens upon the caufe of our late
calamity ; for in pointing out its origin to the fenfes,
we are enabled immediately and certainly to pre-
vent it. But while the only fource of it is believ-
ed to be from abroad, and while its entrance into
our city is believed to be in ways fo numerous and
infidious, as to elude the utmoft pofiible vigilance
of health officers, we are led in defpair to confider
the difeafe as removed beyond the prevention of
human power or wifdom. It has been by adopting
meafures, fimilar to thofe we have delivered for pre-
venting peftilential difeafes, that mod of the cities
in Europe, which are fituated in warm latitudes,
have become healthy in warm feafons, and amidfl
the clofeft commercial intercourfe with nations and
iflands conflantly airlifted with thole difeafes. The
extraordinary cleanlinefs of the Hollanders was ori-
ginally impofed upon them, by the frequency of
peftilential fevers in their cities. This habit of
cleanlinefs has continued to characterize thofe peo-
ple, after the caufes which produced it, have pro-
bably ceafed to be known,

" In thus urging a regard to the domeflic fources
of the yellow fever, we are actuated by motives of
a magnitude far beyond thofe which determine or-
dinary queftions in fcience. Though we feel the
flrongeft conviction that the value of property, the

increafe

BILIOUS YELLOW FEVER IN I jgj. §J

mcreafe of commerce and 'he general profperity of
our city, will be eminently forwarded by the adop-
tion of the foregoing proportions, yet thefe are
but little objects in our view, when compared with
the prevention of the immenfe mafs of diftrefs,
which never fails to accompany a mortal epidemic.
We confider ourfelves moreover as deciding upon
a queftion, which is to affect the lives and happi-
r.efs, not only of the prefent inhabitants of Phila*
delphia, but of millions yet unborn, in every part
of the globe.

" We are with the greatefl refpect,
Sir,

Your very humble fervants,
BENJAMIN RUSH,
CHARLES CALDWELL,
WILLIAM DEWEES,
JOHN REDMAN COXE,
PHILIP SYNG PHYS1CK,
JAMES REYNOLDS,
FRANCIS BOWES SAYRE,
JOHN C. OTTO,
WILLIAM BOYS,
SAMUEL COOPER,
JAMES STUART,
FELIX PASCALIS,
JOSEPH STRONG."
Dec. i; 1797.

5^ AN ACCOUNT OF THE

A few day9 after the publication of this letter,
the following memorial, and narrative of facts, were
prefented to the legillature of Pennfylvania by the
college of phyflcians.

MEMORIAL OF THE COLLEGE OF PHTSICIANS.

ct To the Senate and Houfe of Reprefcntatives of the
Commonwealth of Pennfylvania, the Memorial of
the College of Pbyficians of Philadelphia ref peel-
fully reprefents :

<c THAT your memorialifls, deeply affect-
ed with the calamities produced by the difeafe which
has recently occurred amongft us, are impelled by a
fenfe of duty to their fellow citizens and themfelves,
to inform yon, that they confider the laws which
were enacted for the purpofe of preferving this city
from malignant, contagious diforders, as very im-
perfect.

" The fubject being of immenfe importance, they
hope to be excafed for {taring their fentiments with
refpect to it at large.

" They are of opinion, that the difeafe which
produced fo much mortality and diilrefs in the year

*793*

BILIOUS YELLOW FEVER IN 1 797. 59

1 793, "was imported into this city from the Wert:
Indies ; and they are confirmed in this fentiment,
by the circumftances attending the difeafe of this
year, which they confider as of the fame nature,
and derived from the fame fource.

" Some of their moft important reafons for this
opinion, are as follow : — The difeafe in queftion
is effentially different from the fevers that occur in
this climate, and which originate from domeftic
caufes. This difference particularly regards the ge-
neral progrefs of the fymptoms, and the mortality,
as is evident upon a comparifon of its hiftory with
that of the ordinary difeafes of this city.

M A difeafe which refembles the fever of 1793
and of this year, in many important points, has long
been known in the Weft Indies, and thofe parts of
America fituated between the tropics ; and in fe-
ven or eight different inftances in which a fimilar
difeafe has occurred in the United States, in the
courfe of this century, there is good reafon to be-
lieve that it was derived from thofe countries. In
moft of the inftances, the original hiftory of the
difeafe contains the information that it was import-
ed. In feme cafes, the infection can be traced to
the imported clothing of perfons who died in the
Weft Indies. In moft of the cafes where the im-
portation

Go AN ACCOUNT OF THE

portation cannot be afcertained, the firft appearance
of the difeafe has been, as in the other inftances,
in the neighbourhood of the (hipping, or among
perfons connected with vefTels,

cc The circumftances attending the fever of this
year are extremely in point; and the narrative
which accompanies this, will, we truft, fatisfy you
that it was imported.

cc The difeafe in queftion, commences invariably in
our fea-ports, while inland towns, equally expofed
to the ordinary caufes of fever, efcape ; and in the
two laft inftances of its occurrence in Philadelphia,
the fuburbs and the country adjacent, were more
healthy than ufual at the fame feafon ; and at the
commencement of the difeafe, all the parts of the
city, excepting the fmall fpaces to which it was
confined, were remarkably healthy.

" It exifts in the Weft Indies, particularly in time
of war, when great numbers of ftrangers are to be
found there ; and reference to dates will fliew, that
in mofl: of the inftances of the occurrence of the
difeafe in the United States, there has been war
in the Weft Indies,

" Your

BILIOUS YELLOW FEVER IN 1797. 6l

" Your memorial iffcs are aware, that cafes may be
adduced where the difeafe has occurred in perfons,
who were not known to have been expofed to im-
ported contagions, but fuch is the fubtile nature of
this power, that it often exifls unfufpe&ed ; and
fimilar difficulties occur refpe&ing the fmall-pox,
and other contagions, allowed by all to be of fo-
reign origin. There alfo occur, although very rare*
ly, folitary cafes of malignant remitting fevers, the,
fymptoms of which refemble fo much the difeafe.
in queftion, that they are often fuppofed to be the
fame ; but there is this elfential difference, that a
malignant remittent fever has never been to oun
knowledge contagious in this climate.

" The difference of fentiments among phyficians*
now fo much regretted, refembles that which almofl
always takes place, when the plague .is introduced
into any of the civilized parts of Europe, where it
is not well known. The identity of the difeafe,
its origin and its contagious nature, have been often
the fubjeft of controverfy. Some phyficians have
confidered it as of domeftic origin ; but proper
health laws, ftri&ly enforced, have latterly protect-
ed the commercial parts of Europe from its ravages.

" With thefe fentiments of the nature of the dif-
eafe, your memorialifts cannot but regard a proper

law

62 AN ACCOUNT OF THE

law refpecting the fubject, as a matter of the great-
eft importance, and although they are perfectly
fenfible of the imperfection of the fcience of medi-
cine, yet from a conviction that phyficians are the
beft informed, as well as the mod interefted in the
fubject, they approach you with that refpect which
is due to your legiflative authority, and declare
their belief, that the exifting health laws of this
Commonwealth are not fuch as are beft calculated
to obtain the defired end, and that they ought to
be improved.

" Having lately communicated in writing to the
governor their ideas refpecting the beft methods of
preventing the introduction of contagious difeafes,
they beg leave to refer you to that communication.
At the fame time they tender you their profcflional
aftiftance in .framing an efficient law for this pur-
pofe ; and thus having performed their duty, they
hold themfelves difcharged from all refponfibility,
on account of the evils which may arife from the
prefent imperfect ftate of the legiflative arrange-
ments refpecting this important fubject.

By order of the College,
Attest, JOHN REDMAN, Prefident."

" Thomas C. James, Secretary."

" Philadelphia, Dec. 5//;, 1797."

" Narrative

BILIOUS YELLOW FEVER IN 1/97- 63

u Narrative of fads relative to the probable origin,
and prcgrcfs, of the malignant contagious fever
which lately appeared at the junction of Penn and
Pine flreets.

" THE fliip Arethufa, Captain Keith, fail-
ed about June i, 1797, from Port Royal in Jamaica
for the Havannah, with flaves ; during the paiTage
two men died with a fever, which Mr. Stephen King-
flon, a gentleman of this city, who was a paffenger on
board, and has frequently feen the difeafe, believe*
to have been the yellow fever, one having the
black vomit. After remaining fome days at the
Havannah, the veiTel proceeded for Philadelphia,
and arrived in the ftream oppofite to Pine ftreet,
July 23, 1797. At the capes of Delaware fhe
took on board a pilot, and performed a quarantine
of five days at State Ifland. The pilot was at-
tacked with a fever, the day of their arrival at the
city, and went on more the fame day, when he
was vifited by Dr. Currie, who has been much
converfant with the yellow fever, and was fo fenfi-
ble of the refemblance of his fymptoms to thofe of
that difeafe, that he mentioned the cafe as fufpici-
ous, to one of his friends.

<c The Arethufa was moored at Mr. Jofeph Ruf-
fell's wharf, putfide of two veffels which lay there

when

64 AN ACCOUNT OF THE

■when (he arrived, her crew left her immediately af*
ter ftie was moored, and the next day returned
for their clothing, &c. when they croffed and re-
croiTed the above mentioned mips. Two boys on-
ly and the captain (who was on board occafionally)
compofed the crew of the outermofl (hip, or that
immediately contiguous to the Arethufa ; but the
innermost vefTel, the brig Iris from Oporto, had a
crew of the ufual number. On the twenty-ninth
day of July, five men of this crew were taken ill
with fever, and attended by Dr. J. Stuart, who
ftates in his report to the College of Phyficians,
that the fymptoms were fimilar in all, tho' varying
in the degree of violence ; four of thefe recovered,
but one died with unequivocal marks of the malig-
nant yellow fever. A fervant of George Lati-
mer, Efq. who lived about 100 yards to the north
of this vefTel, and was frequently on the wharves,
was attacked, July 30th, with a fever which wa3
highly contagious and malignant, of which he died
in a few days.

" Mr. N. Lewis, who kept a compting room
which was about the fame diftance from the Arethufa,
was attacked about the fame time, and died alfo in
five days, of a fever which was fuppofed to be of
the fame nature.

Mr,

BILIOUS YELLOW FEVEk IN 1 797. 65

" Mr. Dominick Joyce, who was much engaged
on board a fliip near the Arethufa, was attacked,
Auguft 3d, with a fever of the fame kind, but re-
covered. A man who lived in a ftore on the
fouth fide of Pine ftreet, about 150 yards from
the river, was attacked with a malignant fever
about this time, and died in a few days.

" About the 6th of Auguft, Mr. Fergufon,
whofe yard adjoined the wharf where the Arethufa
and Iris lay, was attacked with a malignant fever>
and the fame day Mr. John Plankinghorn's girl, who
lived nearly oppofite to Mr. Fergufon's acrofs Penn
ftreet, and worked in a yard which was fituated
very near to the above mentioned ftore in Pine
ftreet, was alfo attacked with fever, they both died
on the fifth or fixth day after the attack, Mrs.
Fergufon with very fufpicious, and Mr. Planking-
horn's girl, with complete and unequivocal fymp-
toms of the yellow fever. In this manner the dif-
eafe continued to fpread, fo that by the middle of
Auguft, or within three weeks from the arrival of
.the Arethufa, above ten perfons had died, who
either lived or were engaged in bufinefs within 300
yards of the Arethufa, and this at a time when
the other parts of the city were fo healthy, that
it is probable all the other deaths which occurred
in it were not equal in number to. thofe which oc-

F curred

66 AN ACCOUNT OF THfc

curred in this finall diftrich After this the difeafc
gradually extended itfelf to Southwark, and at the
fame time became thinly fcattered through the city,
where its deilru&ive effects are but too well known.

December 26th, 1797.

Fads relative to the fickly state of the/hip Hind.

" It appears from the depofitions of Francis Tow,
Nicholas Benfon, and William Cooper, feamen on
board the armed fhip Hind, taken before chief
juflice M'Kean, that about the beginning of July
1797, the Hind failed from Port-au-Prince, bound
to Philadelphia, with a cargo of fugar and coffee,
and with 43 paffengers ; of which number 23 were
whites and twenty coloured perfons, that they touch-
ed at Cape Nichola Mole, where they remained
eight days and difcharged a part of their cargo, in
lieu thereof taking in a quantity of ftone ballad ;
during the time they lay at the Mole the paffengers
were occafionally on fhore. It would appear that
they left the Mole between the 12th, and 15th,
of July, and arrived at this port, after a paffage of
twenty or twenty-one days. About three or four
days after their departure from the Mole, five or
fix white perfons and one negro of the paffengers
were attacked with fever, the white perfons fo at-
tacked

BILIOUS YELLOW FEVER IN 1 797. 6 J

tacked were obferved to become very yellow. Dur-
ing the paffage four other coloured perfons and five
of the crew fell ill of fever : one or two of the
latter number, after the vefTel entered the capes of
Delaware ; but only a coloured boy and child died
during the paffage, and were thrown overboard af-
ter the vefTel entered the riv\Tr. Upon the arrival
of the vefTel oppofite to the Marine Hofpital', in
confequence of orders from the captain, four fick
perfons were fecreted and did not come under the
infpection of the Phyfician of the Port ; excluiive
of thefe, two women were fick in the cabin. Af-
ter pafTing the Fort one of the feamen was taken
ill, went on fhore, and was afterwards carried to
the Marine Hofpital ; and two other perfons were
taken on fhore fick. So far go the depofitions.

" From information obtained from the Health Of-
fice, it appears, that the Hind was examined at the
Fort on the 2d, and arrived at Philadelphia on the
4th of Auguft ; and that Mr. Doughty, one of?
the Infpe&ors of the Health Office, fent to the
Marine Hofpital on the 13th of Auguft., Peter
Malofio, one of the crew of the Hind then redding
in Love Lane, and on the 14th a Portuguefe from
near the junction of Penn and South ftreets, who
had been landed there ; and that another perfon
was fick of a fufpicious fever at Mrs. O'Connor's,

F 2 ia

<58 AN ACCOUNT OF THE

in Almond near Front flreet. Both thefc were
from on board the Hind, and the Portuguefe
above-mentioned had been vifited by Dr. Currie,
who declares his difeafe to have been yellow fever.'*

To thefe publications, the following reply was
addreffed to the Gove nor of the fiate.

<c Letter from the Academy of Medicine to Tho-
mas Mifflin, Efq. Governor of the State of Perm*
fylvania.

Sir,

" THE Phyficians, who anfwered your
letter of the fixth of November, respecting the ori-
gin and nature of the epidemic fever which lately
prevailed in the city of Philadelphia, having, with
others of their medical brethren, affociated them-
felves under the name of " The Academy of Medi-
cine of Philadelphia," beg leave, in that capacity,
to addrefs you again upon the interefting fubject of
the faid letter.

" The academy have feen, with regret, a memori-
al, from the college of phyficians of the city, to the le-
giflature, accompanied with a" narrative of facts"

intended to cftablifh an opinion contrary to that,

which

BILIOUS YELLOW TEV2R IN 179/. ^9/

which the fubfcribers of the anfwer to your letter,
conceive they had therein proved in the mod irrefra-
gable manner.

" As the opinion appears to us replete with danger
to the lives of our fellow citizens, and to the prof-
perity of our city, we deem ourfelves bound by the
principles of humanity, and the obligations of patri-
otifm, to make a few remarks upon it ; and to fhew
that it is founded upon partial inveftigations, and
miflaken ideas of the nature of the yellow fever.

" The college have afcribed the origin of the late
epidemic to the mips Arethufa, captain Keith, from
Havanna, and Hind, captain Patot, from Port-au-
Prince. The memorial fets forth that, " the fhip
" Arethufa, capt. Keith, failed about the fird: of
" June, from Port Royal in Jamaica, for the Ha-
M vannah with flaves ; during the pafTage two men
u died with a fever, which Mr Stephen Kingflon, a
<c gentleman of this city who was a pafTenger on
'• board, and has frequently feen the difeafe, be-
" lieves to have been the yellow fever, one having the
" black vomit." Admitting the fitft, which refh
merely upon the belief of a perfon not medically edu-
cated, yet the arguments hereafter to be adduced,
it is prefumed, will deftroy the probability of its be-
ing introduced by this fhip. That the ifland of Ja-
maica

yO AN ACCOUNT OF THE

maica was healthy at the time the Arethufa failed,
appears from the anfwers given by the captain of the
faid mip, to the official interrogatories filed in the
Health-Office relative to this fubjecl ; and from thofe
of capt. Henry Latimer, of the brig Maria, who
failed from the above port about the fame day. That
the difeafe of which the men died was not contagi-
ous is rendered probable by its not having fpread
among the paifengers or crew who amounted to feven-
ty, all of whom arrived in good health at the Ha-
vanna on the 21ft of June. But fuppofmg the dif-
eafe to have been of a contagious nature, the precau-
tions taken after the deaths, would have been fuffi-
cient to have defiroycd any remains of the contagion.
From Mr. Brien's depoiition it appears, that " The
Ci clothing, bedding and articles belonging to the
cc deceafed were thrown overboard, and their births
cc cJeanfed and well fprinkled with vinegar." And
we are authorized furrher to afTert, that the ftiip
underwent fuch a complete cleanfmg while at the
Havanna, after landing the Haves, as prudence
would dictate to a fhip-mafter, in every fimilar cafe.
The fhip, moreover, after lying at the Havanna four-
teen days, during which time all on board remain-
ed well, arrived oppofite the Health-Office on State
Ifland, on the eighteenth of July. During the
whole of this paiTage her hatches were conftantly
open, whereby the moil ample means for a free cur-
rent

BILIOUS YELLOW FEVER IN 1797. 7*

rent of air were afforded, which could not fail to
difiipate any remains of contagion which could poffi-
bly have continued after her former purifications.
The fhip performed five days quarantine oppofite the
health-office, on State-Ifland, during which time the
bedding was every day expofed upon deck and was
once warned by a rain. The crew moreover remain-
ed well, except the captain, who was affected with
a rheumatifm, and the mate, with a lax, both of
whom foon recovered. The pilot who conducted
this fhip was attacked on the twenty-third of July,
and allowing three days for the time he had been ex-
pofed to the contagion before his fever appeared,
there will remain forty-fix days from the time the
fhip left Kingfton till her arrival in our river. From
the known laws of the contagion of the yellow fever,
and the diftance of time at which it ufually appears,
after perfons have been expofed to the contagion,
the academy conceive it fcarcely poffible, if any por-
tion of contagion had been left by the before-menti-
oned perfons, that it would have remained inactive
for above forty-fix days, expofed as the crew were
to the exciting caufes of fatigue, night watching and
the viciflitudes of the weather. The perfect freedom
from difeafe which all on board enjoyed, mud there-
fore be admitted as a proof that no contagion did
exifl, and confequently that the pilot and others
could not have derived their difeafe from that fource.

The

72 AN ACCOUNT OF THE

" The college further (late that " the pilot was at-.
" tacked with a fever, the day of his arrival with the
" fliip at the city, and went on fhore the fame day,
" when he was vifited by Dr. Currie, who has been
" much converfant with the yellow fever,- and who
" was fo fenfible of the refemblancc of his fymptoms
" to thofe of that difeafe, that he mentioned the cafe
" as fufpicious to one of his friends."

" In addition to the arguments, before adduced,
for fuppofing that the pilot could not have taken his
difeafe from any remains of contagion on board, the
academy further remark, that the fource from whence
he derived his difeafe was probably, and as he be-
lieves, from a current of cold air during the night,
while flecping in the open cabin of the fliip, after a
warm day, which preceded that on which the quaran-
tine of the fhip was ended. His indifpofition came
on the next morning, and foon after his arrival in
this city, a violent fever fucceeded, of a kind, which
We every year obferve in Philadelphia, from fudden
changes of the weather, in the fummer and autumnal
months, and efpecially from fimilar expofure on the
river. It may be added, that he was but a few days'
confined, and that none of his friends who nurfed
him, or others who daily vifited him were afFefted
by him ; neither were there any precautions taken
to avoid contagion, nor the leaft intimation of dan-
ger

BILIOUS YELLOW FEVER IN I 797. 73

ger given to thofe who conftantly attended him.
Under all the circumflances which have been men-
tioned, it is impoflible to believe that the pilot's dif-
cafe was derived from an imported contagion.

" The college in their memorial have infmuated
that the crew of the brig Iris were infected with
the yellow fever by the crew of the Arethufa palling
acrofs her deck to the wharf. If this had been true
or even poiTible, it mufl have been in one of the
three following ways : ift. By the actual ficknefs
of the crew ; 2d. By the contagion blowing off
their clothes in pairing over the decks ; or 3d. By
the contagion, which had adhered to the timbers
of the Arethufa, being conveyed by the wind over
two intermediate vefTels to the Iris.

" It is not pretended that any of the crew of the
Arethufa were indifpofed, therefore the firft fuppofi-
tion mufl be rejected. They could not have infect-
ed the crew of the Iris in the fecond mode, becaufe
it is not alleged that they flopped a moment when
pairing over her deck. But admitting they did, it
cannot be believed, that a difeafe could be convey-
ed by their clothes, to the crew of the Iris in the
open air, when it is well known, that thofe clothes
when worn, and even warned in confined lodging
houfes afterwards, did not infect a fingle perfon, in

any

74 ^N ACCOUNT OF THE

any part of the city. Lailly, it is highly impro-
bable that the crew of the Iris could have been in-
fected by the timbers of the Arethufa, becaufe,
•we have no proofs that the contagion of the yellow
fever ever adheres to wood ; but admitting this to
be poffible, we reject the probability of it, becaufe,
as we before obferved, the fhip had been well
cleanfed and freely ventilated on her voyage from
the Havannah to Philadelphia. We are the more
difpofed to afcribe the deftruction of contagion, if
any had exifled, to the pure air of the ocean, from
having fo repeatedly obferved the effects of country
air in weakening or deftroying it in the United
States* The academy are moreover authorifed by
Dr. Stewart to affert, that none of the family, with
whom the five men of the Iris boarded, were infect-
ed ; but that they preferved their health the whole
lime of the prevalence of our late epidemic.

" As the Iris lay at Pine flreet wharf, and entire-
ly within the limits of the exhalations from the fnow
Navigation, to which we formerly referred, it is
highly probable that they were infected thereby,
and that the difeafe was excited by their intempe-
rance in the ufe of Port wine, with which the brig
was loaded, and by the practice of bathing them-
felves in the river while under the influence of li-
quor, and heated by labour. From this conduct it

BILIOUS YELLOW FEVER IN 1 797. 75

is conceived by the Academy, the peculiar violence
of their difeafes can be accounted for, as a fimilar
caufe is always ranked among the moil powerful, in
the production of malignant cafes of bilious yellow
fever ; and Dr. Stewart authorifes the Academy to
alTert his belief, that the fever, in the cafes he com-
municated to the college, proceeded from exhala-
tion ; and he thinks mod probably, that of the
fnow Navigation. *

" Two of the other perfons mentioned by the col-
lege, viz. Mr. Lewis and Mr. Latimer's man, faid
to have been infected by the Arethufa, were much
nearer the fnow Navigation than the Iris was, and
were expofed to the exhalation from the former
veffel. With regard to Mr. Lewis, we fliall ob-
ferve that he was abfent from the city when the
Arethufa arrived, and did not return until fix days
afterwards, which was on the thirtieth of July.
On the flrd of Auguft, the day of his attack, it
is known that he complained very much of the

flench

* Though at an early period of cur late epidemic, Dr.
Stewart fufpe&ed that the crew of the brig Iris were infected
by an intercourse with that of the ihip Arethufa, yet, a far-
tlv.r inveftigation and afcertainment of facls, have fmce fatis-
fisd him that this was not the cafe, but that they mod pro*
bably, as above ftated, derived their difeafe from foul air
iiTuing from the hold of the fnow Navigation.

yS AN ACCOUNT OF THE

flench of the fnow Navigation, which had now per-
vaded the whole neighbourhood, and expreffed
great concern at her being permitted to remain at the
wharf. The Academy are authorifed, by Mr. Do-
minick Jojxe, to exprefs his furprife at the affer-
tion of his having taken his fever from the Arethu-
fa ; for, though his bufmefs led him to the neigh-
bourhood of that fhip, yet he was ftill within the
fphere of the extent of the foul air from the fnow
Navigation, and he acknowledges he was almoft
every day upon the wharf at which this veflel lay,
and from which he, in all probability, derived his
difeafe.

" As all the other perfons whofe cafes are men-
tioned by the college, lived within the extent of the
exhalation from the fnow Navigation, there can be
little doubt, but that they derived it from the fame
air which affected the perfons, whofe names they
have mentioned. It is remarkable, that the difeafe
was in no inflance propagated from any of them.

" The academy have good reafon to believe, that
the perfons who were indifpofed on board the armed
fhip Hind, after her arrival, derived their difeafes
from the noxious air of the fnow Navigation, in
common with the perfons who were affected on
board the Iris, and in the neighbourhood of Mr.
I Latimer's

BILIOUS YELLOW FEVER IN 1797. 77

Latimer's wharf. It appears that none of them
propagated the difeafe to any of their attendants in
the city, or in the hofpital at State Ifland, to which
place fome of them were fent. It is well known,
moreover, that many citizens repeatedly vifited and
fpent whole days on board this veflel, none of
whom were indifpofed in confequence of it.

cc From the depofitions of the fupercargo and of
the pilot of the Hind, it will likewife appear, that
the whole of the teftimony of the three boys is dif-
proved, except as to fome unimportant particulars.*

" We are unable to -give credit to the traditional
rumours of the foreign origin of the yellow fever,
in any part of the United States, inafmuch as from
the inaccuracy of the few records which have been
preferved, of the places from whence it was faid to
be derived, and of the manner in which it wag
faid to have been introduced into our country, we
have reafon to conclude they were aiTumed with-
out fufficient inveftigation. Had the proper fteps
been taken at all times to invefligate its origin, if
is probable it would have been difcovered, in moil
cafes, to have been the offspring of domeftic pu-
trefaction. We cannot clofe the arguments againfl

the

* See Appendix, (B.)

AN ACCOUNT OF THE

the importation of the yellow fever, without re-
marking, that many recent facts and obfervations
render it probable, that the reports of its contagi-
ous nature have been exaggerated, and that it is
not fo often propagated by contagion as has been
fuppofed, more efpecially in warm weather, when-
lick rooms are open night and day, to the conftant
acceflion of frefli air.

" We obferve in the memorial of the college of
phyficians an affertion, that the yellow fever " Is
<c effentially different from the fevers that occur in
" this climate, and which originate from domeftic
" caufes :" but as no proofs are adduced in favour
of that affertion, we fhall reft our opinion of the
original famenefs of both thofe ftates of fever, upon
the facts and arguments which were ftated in our ,
former communication. We fhall only obferve,
that the idea maintained by the college, has been
exploded by fome of the moft diftinguifhed writers
upon tropical difeafes ; and by moft of the Ame-
rican phyficians of the fouthern ftates, who con-
ftantly confider and treat both the common bilious
fever, and its higher grade, called yellow fever,
as the fame difeafe, varying only in violence.

" The academy obferve alfo, with furprife, ano-
ther affertion made by the college, that " The difeafe

" in

BILIOUS YELLOW FEVPR. IN 1797. J§

•c in queftion, invariably commences in our fea-
** ports, while inland towns, equally expofed to the
" ordinary caufes of fever, efcape." To this we
reply, it is well known, that in various parts of the
United States, remote from fea-ports, precifely the
fame difeafe, with all its chara&eriftic fymptoms.,
has frequently prevailed.

" The college in their narrative have taken no
notice of the origin of the yellow fever in Kenfing-
ton, nor at and near Red-Bank upon the eaftern
fliore of the Delaware. Its origin in the former of
thofe places from the noxious air emitted from the
putrid coffee of the fhip Huldah, and in the latter
from marfli exhalation, we conceive to be fully
eftablifhed by the documents communicated in our
appendix. * The college have alfo obferved a total
filence in their report refpefting thofe cafes of yel-
low fever, which appeared in our city, before the
arrival of the Arethufa, Hind, or Navigation.
Thefe cafes were evidently derived from fome of
the numerous fources of exhalation, from putrid
fubftances in and about the city. They were at-
tended by Doctors Rufh, Phyfick, Caldwell, and
Pafcalis.

« i&6

Sec Appendix (C.)

So AN ACCOUNT OF THE

cc We cannot take leave of this important fubjed
without expreffing our earneft defire for its candid
and clofe examination, by the legiflature of the
ftate.

u Fa&s and arguments fimilar to thofe we have
urged, have produced a conviction of the domeftic
origin of the yellow fever, in Bofton, New York,
Baltimore, Norfolk and Charleflon, and many of
the other towns of the United States. This con-
viction has been followed by meafures, in New
York, which promife in future years an exemption
from the diforder.

" With ardent wiflies for the prevalence of truth,
upon this important fubjeel:, in the capital of the
United States, we have the honor to add our mofl
refpe&ful wifhes, for your health and happinefs.

Ctf Signed by order of
The Academy of Medicine of Philadelphia*

" March 20, 1798.

PHILIP SYNG PHYSICK, Prefident.
FRANCIS BOWES SAYRE, Secretary:9

" lo Thomas Mifflin, Efqr.
Governor of Pennfylvania"

APPENDIX.

BILIOUS YELLOW FEVER IN 1797.- 8:

" Appendix.

(A)

" IN feveral interefting particulars, refpecl:-
ing the origin of the epidemic of 1797, mifreprefen-
tations of facts have much deceived the public mind.
Thefe mifreprefentations, we believe to have been
entirely the refult of an eafy credulity, difpofed
to reft fatisfied with popular report, and not of
any fettled intention to miflead. They have been
mod ftriking and fallacious in the accounts propa-
gated, refpecting the origin of the difeafe in Ken-
fington, and at Red-Bank, on the Jerfey fhore of
the river Delaware. * To be able the more effec-
tually to counteract the pernicious influence of fuch.
miftatements, the academy of medicine have found
it neceiTary, to fet on foot particular inveftigations.
The refult of thefe, they now beg permuTion to
fubmit, in the form of a few documents, to the
candid connderation of the public.

• On the fubjeft of the true fourca of the epidemic, in
thefe two fituations, the public are by no means at prefent
in pofTeflion of accurate information.

$2 AN" ACCOUNT OF T^E

" It is known to have been very generally report-
ed, and aJmoft as generally believed, that the late epi-
demic was introduced into Kenfmgton by Mr. John
Brufter, who was faid to have received the infec-
tion by going on board the armed fhip Hind, from
Port-au-Prince. It is true, that Mr. Brufter was,
at lead, among the firft (if not, indeed, himfelf
the very firft) who was attacked by this difeafe in
Kenfington, in the fummer of 1797; but that he
could not poffibly have derived his illnefs from any
intercourfe with the fhip Hind, is a truth unequi-
vocally eftablifhed by the following documents, par-
ticularly by the affidavit of Michael Lynn.

"DOCUMEN T.

66 Proofs of the difeafe, occurring from exhalation in
Kenjingion ; from marfhy grounds ; and from
the hold of a fhip, by Dr. Coxe.

" From the books kept at the Merchants' Cof-
fee-houfe, it appears that the Britifh armed fhip,
Hind, Francis Patot commander, from Port-au-
Prince, was feen below the Fort on the 2d of Au-
guft ; and at ten o'clock of the fame day fhe came
within fight $ and lay off the Fort for examination.

" The

BILIOUS YELLOW FEVER IN 1 797. 83

u The ufual queftions were this day {26. of Aug.)
propofed, by the health-officer, to the commander,
as appears by the paper preferved on the files at
the health-office in this city. She came up to the
city on the 3d ; and entered at the health-office on
the 4th of the month.

cc As no mention is made, previously, of her being
feen in the river ; the probability is that fhe had a
fpeedy paflage up the Delaware.

" The perfon who firft had the yellow fever in
Kenfington, was a young man of the name of John
Brufter. He is faid to have taken the difeafe by
having been on board the Hind ; and through him,
the fever was faid to have been introduced into
Kenfington. Upon an examination into dates, this
is altogether impoffible : Brufter died on the 2d of
Auguft, after an illnefs of four days and four hours,
according to his father's account, which brings the
commencement of his attack to the 29th July, or
four days previoujly to the arrival of the Hind at
the Fort. Exclufively of this fact, I have added
the affidavit of Michael Lynn, to prove that he
did not go on board of any veilel in a voyage down
the river to Reedy Ifland. Some other fource for
his difeafe mud then be looked for ; and this I de-
rive from the marffiy exhalations (arifmg from the

G 2 low

S4 AN ACCOUNT OF TH"

iow grounds and meadows on one or both fides of
the river) to which he was expofed in his pafTage
in a fmall fchooner, to and from "Reedy Iiland in
the middle and clofe of July, aided by imprudent
expofure, by fleepmg upon the wet detk of the
veffel

" Wm. Reed, who died on the 5th of Auguft,
after feven days illnefs, appears in all probability to
have derived his difeafe from fome of the local
fources which are numerous in and about Kenfing-
ton ) although if common report had been credited,
we mould have afcribed it to the picking up of a
calk which was faid to have been thrown from the
Hind. As, however, he died on the 5th, after
feven days illnefs ; the (lory is altogether impofTible,
as it brings die commencement of the difeafe to
the 29th of July, or four day 3 preceding the ar-
rival of the Hind. The fame fources, which in
Kenfingtcn, commonly produce in the autumnal
months, remittents and intermittents, have this fea-
fon by the peculiar couftitutioii of the atmofphere,
("whatever that may be owing to) railed thofe drf-
eafes to the more violent grade of yellow fever*

" To thefe local fources I would alio without hefi-
ration afcribe many of thofe cafes which occurred

BILIOUS YELLOW FEVER IN 1 79;. 85

in Kenfington, and which were all aiTertcd to be
traced to contagion.

" In that range of houfes, extending northward
from the bridge over Kohockfmg creek, and to the
weft of the main York road, not lefs than fix or
feven people died of the yellow fever. Thefe houfes,
it will be recoilecled, are bounded on the wed by
that large portion of low marfliy ground to the
northward of the bridge ; and from this abundant
fource of exhalation, I think it mod rational to
deduce the feeds of the fever which occurred there.
And this is rendered much more probable by the
collateral evidence, of the fame fever having exid-
ed in the families of Mr. Boudinot and Mr. Learn-
ing, near the Frankfort road, where low and
marfliy grounds aiiord ample origin to thofe noxious
miafmata which produce intermitting and remitting
fevers. The draggling manner alfo, in which the
difeafe occurred in Kenfmgton, renders it mere
probable that it originated from local fources, than
that it was introduced and fpread through the me-
dium of contagion.

" The next perfons who were attacked in Ken-
fmgton, were in the family of Mr. Jofeph Bowers.
Thefe appear to have received the difeafe from the
noxious miafmata originating in the hold of a fhip

called

85 AX ACCOUNT OP TH!

called the Huldah, which went up to Kenfington to

clear out at Mr. Bowers' wharf, after difcharging
her cargo in this city. The following is the ftate-
ment procured reflecting this fhip,

chiefly from the houfe of Summerl and Brown, to
whom (he was cornigncd.

c: The Clip Huldah, captain William Warner,
failed from this port for Hamburgh, on the 1 8th of
October, 1796, laden with coffee, fugar, and furs.
After landing her cargo, me does not appear to
have cleared out her ballair, Sec. but failed from
Hamburg for this place on the 1 ith of Apri], 1797,
laden with hemp, iron, cordage, dry goods, glafs,
and brandy, She arrived at New York on or about
id day of July, where me difcharged 109
pipes of brandy. On the 15th, fhe failed for Phi-

[phia, and entered at the health-office on the
17th of the month, having 13 feamen on board
in perfect health, which had been the cafe during
the whole voyage of upwards of ninety days. She

harged her cargo at Vanrruxem's wharf, be- .
tween Arch and Race ftreets, and on Sunday the
13th of Augufr, (he was carried to Mr. Bowers'

irf at Kenfington, by the mate and one of the
failors, (jofeph Way of Wilmington, nephew to
the late Br. Nicholas Way, of this city) affiled
by Nicholas Painter of Kenfington. They proceed-
ed

EILIOUS YELLOW FEVER IX IJQT. 87

cd to clear her out the following day, Auguil 14th.
After getting through a quantity of (arid, which
lay above the ballad, fo naufeous and offenfive a
fmell proceeded from her, that the mate was indif-
pofed for feveral days. Jofeph Way was obliged
to lay by ; and after drooping ibme days, he went
down to Wilmington, and there died, with a fevere
attack of the yellow fever, on the fame day with
his uncle, in this city, viz. on the 2d of Septem-
ber.

" Nicholas Painter and Chriftopher Rufh, who
affifted in cleaning her out, flood the eilecls of this
exhalation till Wednefday, 16th of Augud ; when
they were feized with violent head-ach, efpecially
above the eyes ; ficknefs and vomiting, and pain
of the back ; accompanied by fever. Rufh fays,
he has never completely regained his health fince
that period. He further fays, that the fmell of
the hold of the Huldah was fo naufeous, that he
could not get it out of his nofe for feveral days.

" Upon invefligation it appeared, that the fmell
proceeded from a quantity of coffee, (which muft
have efcaped during the voyage to Hamburgh)
mixed with the bilge water and fand, and which
was in the higheil ftate of vegetable puirefa-fiion ;

being

8$ AN ACCOUNT OF THE

being very black, and containing worms or mag-
gots nearly two inches in length.

cc Mr. Jofeph Bowers' boy was the firir. of his fa-
mily who was attacked. He worked in a fchooner
which lay along-fide of the Huldah, and was feized
on Tucfday, the 15th of Augud, and died on the
2 2d. Mr. Bowers himfelf feems to have received
the feeds cf the difeafe on Tuefday, the 15th, at
which time he was on board the Huldah, and no-
ticed the very offenfive fmell proceeding from her
hold. He fickened on the Sunday following, the
20th of Augud, and died on the 25th. A maid-
fervant and two children alfo had the difeafe ; one
of the children died. It is poflible that thefe lad,
took the difeafe by contagion from Mr. Bowers or
his boy ; though I think it more probable, that
they derived it from the original fource, viz. the
Blip's hold ; as the wharf is not very didant from
the houfe, and as yet we know not the exact, limits
to which thefe noxious miafmata may be carried,
without lofing their baneful influence by dilution
with the atmofphere.

Many cafes which occurred in Kenfmgton after
this period, were, mod probably, derived from this
fource. The accounts of them are altogether wrapt
in doubt and fuppoiltion. Mod of them are faid to

have

BILIOUS YELLOW FEVER IN 1 797. 89

have taken it by contagion from others ; but this
is rendered highly improbable by the very mode-
rate degree in which this fever has evinced itfelf to
be poflefled of a contagious power ; and more
cfpecialiy in fo airy and extended a village as that
of Kenfmgton.

" It would appear then, from the preceding
pages, that the difeafe as it exifled in Kenfmgton,
had three different fources, viz.

(C First ; By exhalation or marjh-ejflwu ia, derived
from the low grounds on the banks of the Dela-
ware ; as was the cafe with Bruster.

" Secondly; From exhalation or marfh-effluvia,
derived from the local fources of low grounds in,
and about Kenfmgton ; as evinced in thofe cafes
which occurred in the range of buildings, to the
weflward of the York road : and,

cc Thirdly ; From the exhalation or noxious
effluvia, proceeding from putrefying vegetable mat-
ter, in the hold of the fhip Huidah ; as in the cafes
of Mr. Bowrers and his family, and perhaps in
others.

The

90 AN ACCOUNT OF THE

" The difeafe, pofiibly, in forne few cafes fpread
by contagion. King, a coffin-maker, who affiled
in putting the dead into their coffins, may have de-
rived his difeafe, of which he died, from this
fource. It is however problematical ; for he was
with others, expofed to thofe caufes which produ-
ced it in them.

JOHN REDMAN COXE."
" Philadelphia, Decern-^}
ber i, 1797." 3

Affidavit of Chriftopher Rum.

«* County of Philadelphia^.

" Perfonally appeared before me, Peter Brown,
one of the juftices of the Peace, in, and for the
county aforefaid, Chriftopher Rulli ; and being du-
ly fworn upon the holy evangelifts, did depofe, and
fwear, that, in working on board the lhip,
Huldah, at Jofeph Bowers' wharf, on the 14th of
Auguft laft, he perceived a mofl oftenfive fmell on
board the faid fliip, ariling from fome putrefied
coffee in the hold of the fhip. That he, the faid
Chriftopher Ru&, was made fick for feveral days

from

BILIOUS YELLOW FEVER IN 1 797. QX

from the faid fmell, as alfo were Nicholas Painter
and Jofeph Way, who worked with faid Chriftopher
Rufh on board the fhip Huldah. He depofeth fur-
ther, that Jofeph Bowers and his man ware expofed
to the faid fmell, from working and attending on
board the faid fliip ; and further this deponent fay-
cth not.

his
" CHRISTOPHER C. R. RUSH,
mark.
" Taken and fubferibed before me1, this 30th day
of November, 1797.

c- Signed,
" fSeal) PETER BROWN."

A true copy, J. R. Coxe.

Affidavit of Michael Lynn.

" County of Philadelphia, Jf.

Ci Perfonally appeared before me the fubferiber,
one of the Juflices of the Peace, in, and for the
county aforefaid, Michael Lynn ; who being duly
fworn upon the holy evangeliits, doth depofe and
fay, that on the 17th day of July lad, he accompa-
nied John Brufter from Kenfington, at which place

the

92 AN ACCOUNT OF THE

the deponent refides, down the river Delaware, in a
fraall fchconer, and returned home on the 23d day
of July, making an abfence of fix days ; during
which time, neither the deponent nor the faid John
Brufter was on board of, or along fide of, any fhip
or veffel whatfoever ; and that on the Sunday fol-
lowing, which was exactly one week after their re-
turn, John Brufter was taken fick, and died the
Thurfday following.

" Signed MICHAEL LYNN.

" Taken and fubfcribed before me, this 30th
day of November, 1797,
" Signed,
« (Seal) ^ PETER BROWN."

A true copy, J. R. Coxe.

" Copied from the original documents, in the pof-
feflion of the fecretary of the flate of Pennfylvania.

J. R. C.

u The academy of Medicine cannot do other wife
than exprefs their furprife, that the College of phyfi-
cians, in their refearches after the origin of our late
epidemic, fhould have thought it neceffary to make
the armed fhip Hind an object: of attention. It is a
truth well known, that the fever had prevailed in
our city feveral days previoufly to the arrival of that

veffel 1

BILIOUS YELLOW FEVER IN 1797. 93

veffel j and it is, in like manner, a truth which
ought to be known, that none of thofe perfons fup-
pofed to have been infe&ed by an intercourfe with
her, communicated their difeafe to any of their vifit-
tants or attendants. Where then, the academy
would beg leave to aik, is even the fainted evidence,
of the fhip Hind having been at all inftrumental, in
the introduction of this difeafe ? There certainly ex-
ifts none. Nor, in a candid inveiligation of the
fubjecl, does there appear to be ground fufficient to
authorife, even the mention of the name of this vef-
fel.

M As the college of phyficians appear, however, by
their late pamphlet, to have directed to the Hind,
an undue (hare of public attention, it has become ne-
ceifary to make their narrative refpecting her, a fub-
ject of particular confideration. The only evidence
of which that learned body are poffeffed, refpe&ing
the fickly date of this veffel, is derived from the af-
fidavits of three common mariners belonging to her
crew ; two of whom were nothing more than boys.
In oppofition to the evidence delivered in thefe affi-
davits, we would here beg leave to fubmit to the
public, the affidavit of the fupercargo of the Hind.
The report, delivered in his depofltion, is farther
corroborated by the joint teftimony of three other
refpe&abk cbara&ers, on board the fame veffel.

From

p.£ AN ACCOUNT OF THE

From this document, it will at once appear, on how
equivocal a foundation, the college have thought
proper to reft this part of their inveftigation, refpeft-
ing the origin of the difeafe in queftion.

" Affidavit of the Supercargo of the Hind,

" Perfonally, before me, Hilary Baker, Mayor of
the city of Philadelphia, came Thomas Badaraque ;
who being duly fworn, doth depofe and fay, that
he was fupercargo of the {hip Hind, captain Patot,.
from Port-au-Prince to Philadelphia, in the fummer
of 1797. That they touched at Cape Nichola
Mole, and five days after, a child, about fix months
old, died from teething: that a negro boy, of about
nine years of age, died of the fcurvy, the day be-
fore the pilot came on board. That no other per-
fons were fick during the voyage, except Mr. Cam-
pan a paffenger, who had been indifpofed, before
he came on board, with a lax, and other chronic
complaints. That no orders were given to conceal
any body, upon the arrival of the fhip, by the cap-
tain, from the phyfician at the fort.

T. BADARAQUE.

Sworn, the 15th day of March, 1798, before me,
HILARY BAKER, Mayor.

" The

EILIOUS YELLOW FEV£R IN 1797. 9^

*c The under-figned, paflengers on board the fliip
Hind, at the time alluded to, having been duly
fworn, do depofe and fay, that the facts above re-
lated, by Thomas Badaraque, are juft and true.

MATHIEU DUPOTEE.
PIER VIDAU.
PONIMIER.

Sworn, the 15th day of March, 1798, before me9
HILARY BAKER, Mayor.

(C)

cl By fome, the yellow fever, which prevailed at or
near Red-bank, is fuppofed to have originated from
an imprudent communication with the (hipping in
the river, while others alledge, that it was derived
from an intercourfe with the city of Philadelphia.
That both thefe allegations, however, are equally
unfounded, is a truth, which the Academy of Me-
dicine conceive to be fatisfa&orily efiablifhed by the
following

" DOCUMENT, by Dr. Otto.

•* I do hereby certify, that I vifited the farms at
and in the vicinity of Red-bank, fituated on the

eaftera

t)6 AN ACCOUNT OF THE

eaflern fliore of the Delaware, for the purpofe of
inveftigating the origin of the yellow fever, that
raged fo violently amongft them, during the late
autumn. I fought every poflible information from
the attending phyfician, the families who had been
attacked, and from their neighbours. Knowing
that a difeafe of this kind might have been derived
from domeflic fources, from the city of Philadelphia,
and, poflibly, from the (kipping performing quaran-
tine, I was exceedingly particular upon thefe points
of inquiry and investigation. After examining the
documents upon this fubjec*t, I do not hefitate to
pronounce it the offspring of local caufes.

M The moft valuable part of thefe farms confuts
in meadows, which had been overflowed, for ten or
twelve days, by a deluge of rain that commenced on
the firft of Auguft. The waters gradually difap-
peared, and depofited a fcUm that was exceedingly
naufeous. The roots of the grafs were dead in many
places for an acre or more in extent; even fix inches
below the furface of the earth, they were deftroyed-^-
ihe vegetable putrefaction was great, and the fmell
arifing from it extremely difagreeable. To this
fource I attribute the difeafe that prevailed amongft
them. Twenty-nine perfons were attacked in five"
families ; but fo local was the calamity, that, al-
though the neighbours kept up a conftant communi-
cation,

BILIOUS YELLOW FEVER IN 1 797. 97

cation, by vifiting the ;fick rooms, and rendering
their fervices, no perfon, that thefe families recol*
Je<ft, was affected with it, in confequence. And
there is but one poffible cafe in which it could have
been communicated, by any one of thefe families to
any of the others*

My opinion of the local origin of the yellow fever,
derives fupport from its being the idea of the phy-
fician who attended the fick, and the univerfal fenti-
ment of thofe who have fuffered by it. Documents,
entering into detail, to eftablifh thefe, and a variety
of other points connected with the difeafe, are fub-
fcribed by all the perfons alluded to, and depofited
among the records of the Academy of Medicine.
Signed, JOHN C. OTTO.

March 23^, 1798*

There is one affertion by the college of phyfl-
cians, which has efcaped refutation by the academy
of medicine. It is faid in the memorial of the col-
lege, that the yellow fever " exifts in the Weft Indies
" particularly in the time of war, when great num-
" bers of ftrangers are to be found there, and refer-
*6 ence to dates will fliew that in moil of the inftan-

H Ck ces

98 AN ACCOUNT OF TJiE

" ces of the occurrence of the clifeafe in the United
" States, there has beeu war in the Weft Indies*"

It appears that the difeafe was unknown in the
United States during the iaft war in the Weft Indies,
and that it prevailed but once in America during the
war before the laft, and that was in Philadelphia in
1762. It ought to be remembered in this place, that
the intercourfe between the Weft India Iilands and
the United States at that time, was of fuch a nature,
as to favour the importation of the fever, much
more than it has been flnce, for American troops
who had ferved with the Britifh army in the Weft
Indies arrived occafionally with the remains of the
yellow fever upon them, and yet in no inftance
was the difeafe imported by them. The fever in
Philadelphia in 1 762 was generated by putrid exhala-
tions from the dock near the draw-bridge. I infer
this from its prevailing chiefly in that neighbourhood,
and from its being rarely contagious when carried
into any other part of the city. — It was believed, it
is true, at the time, to have been imported. The
reader muft not be furprifed at this traditional error
having been adopted by the citizens of Philadelphia
without examination, when he recollects that the
college of phyficians of Philadelphia have twice a-
dopted it after a formal inveftigation of the origin of

the

BILIOUS YELLOW FEVER IN 1J9J* 99

the difeafe, without the leaft evidence from fa&s,
or principles in fupport of their opinion.

It is to be lamented that the legiflature of the (rate
took no notice of the proofs of the domeftic 6rigin
of the yellow fever which were laid before them by
the academy of medicine. A law was palfed to pre-
vent the importation of the difeafe. It has fince
been enforced with a rigor which has been expen-
five and diftreiEng to the commerce of the city. I
wifh it may not be the means of generating the dif-
eafe, by obliging mips to remain ten days at State
Ifland in the hot months, with vegetable cargoes
putrefying in their holds ; or if this fhould not be
the cafe, I hope the law will not compel the owners
of veflels who have been exhaufted by the expenfes,
or fea captains who have been worn down by the fa-
tigue of tedious voyages, to feek a more open port in
fome of the rival cities of the United States, where
jufl opinions prevail refpecting the ufual origin of
the yellow fever. A belief in the importation of the
epidemics of 1793 and 1797 is difgraceful to the
fcience of medicine ; and unlefs man fhould become
retrograde in the ufe of his reafoning faculties, the
records and laws which are intended to eftablifh this
belief, will probably be preferred with the laws
againft witchcraft, as curious monuments of the

H 2 weaknefs

OF THE

derftanding, at the clofc

I have taken pains to collect an account of all the
vegetable and animal matters which,, in a flate of pu-
trefaction, produce bilious, remitting and malignant
fevers. The following is a lift of fuch of them as I
have met with in books, or picked up from conver-
fation, and obfervation.

i. Matters which compofe marfh exhalations, and
which are fuppofed to be partly of a vegetable, and
partly of animal nature. They are derived from
the fhores of rivers, creeks and mill-ponds, as
well as from low and wet grounds.

2. Cabbage.

3. Potatoes.

4. Pepper.

5. Indian meal.

6. Onions.

7. Mint.

8. Annifeed

•BILIOUS YELLOW FEVER IN 1 797. IOI

8. Annifeed and caraway feed confined in the
hold of a fliip.

9. Coffee. — " About the time," fays Dr. Trot-
ter, " when notice was taken of the putrefying
coffee on the wharf at Philadelphia, in the year
1793, a captain of a man of war jufl returned
from the Jamaica ftation, informed me, that feve-
ral velfels laden with the fame produce came to
Kingfton from St. Domingo. During the diftracl:-
ed ftate of that colony, this article, with other
productions, had been allowed to fpoil and fer-
ment. The evolution of a great quantity of fixed
air, or carbonic acid gas, was the confequence ;
and in thefe veffels, when opening the hatchways,
fuch was its concentrated ftate, that the whole of
the crew in fome of them, were found dead on the
deck. A pilot boarded one of them in this condi-
tion, and had nearly perifhed himfelf."*

10. Cotton, that had been wetted on board of
a veffel that arrived in New York a few years ago
from Savannah in Georgia.

1 1 . Hemp, flax, and ftraw.

12. The

* Medicina Nautica, p. 324,

102 AX ACCOUNT OF TH^

12. The canvafs of an old tent.

13. Old books and old paper money that had been
wetted, and confined in ciofe rooms and clofets.

14. The timber of an old houfe. A fever pro-
duced by this caufe is mentioned by Dr. Haller in
his Bibliotheca Medicince.

15. Green wood confined in a clofe celiar during
the fummer months. A fever from this caufe was
once produced in this city in a family that was at-
tended by the late Dr. Cadwallider.

16. The green timber of a new mip. Captain
Thomas Bell informed me, that in a voyage to the
Eafl Indies in the year 1784, he loft fix of his men
with the fcurvy, which he fuppofed to be derived
wholl) from the foul air emitted by the green timber
of his {hip. The hammocks which were near the fides
of the fiiip rotted during the voyage, while thofe
which were fufpended in the middle of the mip re-
tained their found and natural ftate. This fcurvy
has been lately proved by Dr. Claiborne in an inge-
nious inaugural dilTertation publiihed on the 22d of
May of the prefent year, to be a mi i placed ftate of
malignant fever. Dr. Lind mentions likewife the

timber

BILIOUS YELLOW FEVER IN 1 797. I03

timber of new fhips as one of the fources of febrile
difeafes.

1 7. The flagnating air of the hold of a ftiip.

18. Bilge water.

1 9. The flagnating air of clofe cellars. To pre-
vent this fource of fever, chimneys fhould always
be made in them.

20. The matters which ufually flagnate in the
gutters, common fewers, docks, and alleys of cities,
and in the fmks of kitchens.

21. Air emitted by agitating foul, and flagnating
water. Dr. Franklin once derived an intermitting
fever from this caufe.

22. A duck-pond, and

23. A hog-ftye have been known to produce vio-
lent bilious fevers in Philadelphia.

Fevers are feldom produced by decayed or putrid
animal matters. There are, however, records of
their having been generated by the following fub-
fiances in a Hate of putrefaction.

1. Human

104 AN ACCOUNT OF THE

i. Human bodies that have been left unburied
upon a field of battle,

2. A whale thrown upon the feafhore in Holland,

3. Locufls.

4. Raw hides confined in ftores and in the holds
of Slips, and

5. The entrails of fifh expofed to the heat of
the fun.

The following fact communicated to me by Mr.
Samuel Lyman, a member of Congrefs from the
flate of MafTachufetts, fhews the importance of at-
tending to the condition of butchers meat in our
attempts to prevent malignant fevers.

A farmer in New Hampfhire who had overheated
a fat ox by exceflive labour in the time of harveft,
perceiving him to be indifpofed, inftantly killed him,
and fent his flefli to a neighbouring market. Of
24 perfons who ate of this flefli, 15 died in a few
days. The fatal difeafc produced by this aliment,
fell, with its chief force, upon the ftomach and

bowels.

The

BILIOUS YELLOW FEVER IN 1797. I05

The gentlemen who fubfcribed the firft letter to
the governor of Pennfylvania, have remarked, that
an offenfive fmell is not eiTential to the nature of
thofe gafes which produce fevers. It is poflible
this fmell, by exciting a morbid action in the nofe,
may prevent their being felt in more vital parts of
the body. It would feem further, as if heaven
had kindly connected a difagreeable fmell with pu-
trefying vegetable and animal matters, on purpofe
to prompt us to remove or avoid them.

From a review of the numerous and common
caufes of fever which have been mentioned, we
are led again to lament that they have been fo long
overlooked and neglected by the citizens of Phila-
delphia. We behold here a melancholy inftance
of the force of prejudice, prevailing, not only over
reafon, but over the evidence of the fenfes them-
felves. While the inhabitants of our city are look-
ing with terror to the mips which arrive from the
Weft. Indies in the fummer months, and fliunning
even the refrefhing breezes which fill their fails at
the diflance of five or fix miles, it appears that the
true caufe of all their peflilential calamities, like
the fin of Cain, " lieth at their door."

I proceed now to fay a few words upon the treat-
ment which was ufed in this fever. It was in ge-
neral

Io6 AN ACCOUNT OF TH£

ncral the fame as that which was purfued in the
fevers of 1793 and 1794.

Ibegan the cure, in mod cafes, bf bleeding,
where I was called on the firfl day of the difeafe,
and was happy in obferving its ufual falutary effe&s
in its early ltage. On the fecond day, it frequently
failed of doing fervice, and on the fubfequent days
of the fever, I believe it often did harm ; more
efpecially if no other depleting remedy had preced-
ed it. The violent action of the blood-veffels in
this difeafe, when left to itfelf for two or three
days, fills and fufFocates the vifcera with fuch an
immenfe mafs of blood, as to leave a quantity in
the veffels fo fmall, as barely to keep up the ac-
tions of life. By abflra&ing but a few ounces of
this circulating blood, we precipitate death. In
thole cafes where a doubt is entertained of fuch an
engorgement of fiagnating blood having taken place,
it will always be fafefl to take but three or four
ounces at a time, and to repeat it four or five times
a-day. By this mode of bleeding we give the vif-
cera an opportunity of emptying their fuperfluous
blood into the veffels, and thereby prevent their
collapfing from the fudden abflra&ion of the ftimu-
lus which remained in them. I confine this obfer-
vation upon bleeding, after the firfl flage of the dif-
eafe, only to the epidemic of 1797, It was fre-
quently

BILIOUS YELLOW FEVER IK I/9/, I07

quently effectual when ufed for the firfl: tiir.e after
the firft and fecond days in the fevers of 1793 and
1794, and it is often ufeful in the advanced ftage
of the common bilious fever. The different and
contradictory accounts of the effects of bleeding in
the yellow fever in the Well: Indies, probably ori-
ginate in its being ufed in different flages of the dif-
eafe. Dr. Jackfon, of the Britifh army, in his
jate vifit to Philadelphia, informed mc, that he had
cured 19 out of 20 of all the foldiers whom he
attended, by copious bleeding, provided it was
performed within fix hours after the attack of the
fever. Beyond that period, it mitigated its force,
but feldom cured. The quantity of bleed drawn
by the Doctor, in this early ftage of the difeafe,
was always from 20 to 30 ounces. I have faid the
yellow fever of 1797 was more malignant than the
fevers of 1793 an^ J794' ^ts refemblance to the
yellow fever in the Weft Indies, in not yielding to
bleeding after the firfl day, is a proof of this affer-
tion.

I was (truck during my attendance upon this fe-
ver in obferving the analogy between its mixed
form and the malignant ftate of the fmall pox. The
fever in both, continues for three or four days with-
out any remiffion. They both have a fecond ftage
h which death ufually takes place if the difeafes be

left
\

Io8 AN ACCOUNT OF THE

left to themfelves. By means of copious bleeding
in their firft, they are generally deprived of their
malignity and mortality in their fecond flage. This
remark fo trite in the fmall pox, has been lefs at-
tended to in the yellow fever. The bleeding in the
firft flage of this difeafe does not it is true deflroy it al-
together, any more that it deflroys an eruption in
the fecond flage of the fmall pox, but it weakens it
in fuch a manner, that the patient paffes through its
fecond flage without pain or danger, and with no
other aid from medicine than what is commonly de-
rived from good nurfing, proper aliment, and a little
gently opening phyfic.

It is common with thofe practitioners who object:
to bleeding in the yellow fever, to admit it occafion-
ally in robust habits. This rule leads to great error
in practice. From the weak action of predifpofmg,
or exciting caufes, the difeafe often exifts in a feeble
flate in fuch habits, while from the protracted, or
violent operation of the fame caufes, it appears in
great force in perfons of delicate conflitutions. A
phyfician therefore in prefcribing for a patient in this
fever, fhould forget the natural ftrength of his muf-
cles, and accommodate the lofs of blood wholly to
the morbid ftrength of his difeafe,

BILIOUS YELLOW FEVER "IN 1797. Io9

In a former work* I hinted at thofe ftates of
this fever in which bleeding is proper. Dr. Jackfon
has confirmed me, by his inftruc"Hng communications
upon this fubject, in all the remarks which I have
publifhed, and has added to them a caution which
deferves the attention of practitioners, and that is, to
avoid bleeding in the clofe of a paroxyfm of the
fever. The debility which accompanies the inter-
mhTion of the fever is often fo much increafed by
this evacuation, as to endanger life.

The quantity of blood drawn in this fever was al-
ways proportioned to its violence. I cured many by
a fingle bleeding. — A few required the lofs of up-
wards of an hundred ounces of blood to cure them.
The perfons from whom that large quantity of blood
was taken were Meffieurs Andrew Brown, Horace
Hall, George Cummins, J. Ramfay and George Eyre.
But I was not fmgular in the liberal and frequent
ufe of the lancet. The following phyficians drew the
quantities of blood annexed to their refpective names
from the following perfons, viz.

Dr. Dewees 176 ounces from Dr. Phyfick,

Dr. Griffitts 1 1 o from Mr. S. Thomfon,

Dr. Stewart 106 from Mrs. M'Phail,

Dr-

* Medical Inquiries and Obfervations, vol. iv.

IIO A1ST ACCOUNT OF THE

Dr. Cooper 150 from Mr. David Evans,

Dr. Gillcfpie 103 from himfelf.

All the above named perfons had a rapid and eafy
recovery, and now enjoy good health. I loft but
one patient who had been the fubject of early and
copious bleeding. Kis death was evidently induced
by a fupper of beef-flakes and porter after he had
exhibited the moil promiling figns of convalefcence.

I am aware how much I fliall detract for the pre-
fent from the reputation of thofe phyllcians whofe
names are connected with the records of the above
facts. But I know them too well to fuppofe they
wifli to accommodate to the prejudices of the day,
by concealing their modes of practice. Fear and er-
ror will not always maintain their ground upon this
fubject. The objections to copious bleeding in ma-
lignant fevers, will fooner or later lleep with the pre-
judices againfl bark and opium. Ample juflice will
then be done to thofe men who have fubmitted to a
temporary facrifice of interefl and reputation, in or-
der to fave the lives of their fellow creatures.

Of PURGING.

From the great difficulty that was found in dif-
sharging bile from the bowels by the common modes

BILIOUS YELLOW- FEVER IN 1797. Ill

of adininiftering purges, Dr. Griffitts fuggefted to me
the propriety of giving large dofes of calomel with-
out jalap, or any other purging medicine, in order
to loofen the bile from its clofe connection with the
gall-bladder and duodenum during the firft day of
the difeafe. This method of difcharging acrid bile
was found ufcful. I obferved the fame relief from
large evacuations of fcetid bile in the epidemic of
1797 that I have remarked in the fever cf 1793".
Mr. Bryce has taken notice of the fame falutary ef-
fects from fimilar evacuations in the yellow fever on
board the Bufbridge Indiaman in the year 1792.
His words are, " It was obfervable that the more
dark coloured, and fcetid, fuch difcharges were, the
more early, and certainly, did the fymptoms difap-
pear. Their good effects were fo inftantaneous,
that I have often feen a man carried up on deck per-
fectly delirious with fubfukus tendinum, and in a
date of the greatefl apparent debility, who after one
or two copious evacuations of this kind, has return-
ed of himfelf, and aftonifhed at his newly acquired
ftrength." * Very different are the effects of tonic
remedies when given to remove this apparent debility.
The clown who fuppefes the crooked appearance or
a flick, when thrufl into a pail of water, to be real,
does not err more againft the laws of light than

that
* Annals of Medicine, p. 123.

112 AN ACCOUNT OF TH£

that phyfician errs againft a law of the animal ceco-
nomy, who miftakes the debility which arifes from
oppreifion, for an exhaufted ftate of the fyftem, and
attempts to remove it by flimulating medicines.

After unlocking the bowels by means of calo-
mel and jalap in the beginning of the fever, I found
no difficulty afterwards in keeping them gently open
by more lenient purges. In addition to thofe
which I have mentioned in the account of the fever
of 1793, I yielded to. the advice of my friend Dr.
Griffitts, by adopting the foluble Tartar, and gave
fmall dofes of it daily in many cafes. It feldom
offended the ftomach, and generally operated, with-
out griping, in the mofl plentiful manner.

However powerful bleeding and purging were
in the cure of this fever, they often required the
aid of a salivation to aim! them in fubduing it.

Befldes the ufual methods of introducing mercu-
ry into the fyftem, Dr. Stewart accelerated its ac-
tion by obliging his patients to wear focks filled
with mercurial ointment ; and Dr. Gillefpie aimed
at the fame thing by injecting the ointment in a
fuitable vehicle into the bowels in the form of
glyfterSi

The

BILIOUS YELLOW FEVER IN Ijqj. I 13

The following fa£ communicated to me by Dn
Stewart, will (hew the fafety of large dofes of
calomel in this fever. Mrs. M'Phail took 60 grains
of calomel, by miftake, at a dole, after having
taken three or four dofes, of 20 grains each, on
the fame day. She took, in all, 356 grains in fix
days, and yet, fays the Doctor, " fuch was the
ftate of her ftomach and inteftines, that that large
quantity was retained without producing the leafl
griping, or more ftools than fhe had when fhe took
three grains every two hours."

I obferved the mercury to affect the mouth and.
throat in the following ways. 1. It fometimes pro-
duced a fwelling only in the throat refembling a
common inflammatory angina. 2. It fometimes
produced ulcers upon the lips, cheeks, and tongue,
without any difcharge from the falivary glands. 3.
It fometimes produced fwellings and ulcers in the
rums, and loofened the teeth without inducing a,
falivation. 4. There were indances in which the
mercury induced a rigidity in the mafTeter mufcles
of the jaw, by which means the mouth was kept
conftantly open, or fo much clofed, as to render it
difficult for the patient to take food, and impof-
fible for him to maflicate it. 5. It fometimes
affected the falivary glands only, producing from
them a copious fecretion and excretion of faliva.

I But,

114 AH ACCOUNT OF THE

But. 6. It more frequently acted upon all the above
parts, and it was then it produced mod fpeedily its
falutary effects. 7. The difcharge of the faliva fre-
quently took place only during the remhTion or in-
termiiTion of the fever, and ceafed with each return
of its paroxyfms. 8. The falivation did not take
place in fome cafes until the folution of the fever.
This was more efpecially the cafe in thofe forms of
the fever in which there were no remrffions or inter-
miflions. 9. It ceafed in mod cafes with the fever,
but it fometimes continued for fix weeks or two
months, after the complete recovery of the patient.
10. The mercury rarely diflodgcd the teeth. Not
a Angle inftance occurred of a patient lofing a tooth
in the city hofpital where the phyficians, Dr. J.
Duffield informed me, relied chiefly upon a faliva-
tion for a cure of the fever. 1 1 . Sometimes the
mercury produced a difcharge of blood with the
faliva. Dr. Coulter of Baltimore gave me an ac-
count in a letter, dated the 17th of September,
1797, of a boy in whom an hemorrhage from the
falivary glands excited by calomel, was fucceeded
by a plentiful flow of faliva, which faved his pa-
tient. I faw no inconvenience from the mixture of
blood with faliva in any of my patients. It occur-
red in Dr. Caldwell, Mr. Bradford, Mr. Brown,
and feveral others.

BILIOUS YELLOW JEVER IN 1797. IIJ

It has been faid that mercury does no fervice un-
lefs it purges or falivates. I am difpofed to believe
that it may aft as a counter ftimulus to that of the
miafmata or contagion of the yellow fever, and
thus be ufeful, without producing any evacuation
from the bowels or mouth. It more certainly acts
in this way, provided blood-letting has preceded
its exhibition. I have fuppofed the ftimulus from
the remote caufe of the yellow fever to be equal in
force to five, and that of mercury, to three. To
enable the mercury to produce its action upon the fy-
ftem, it is neceffary to reduce the febrile action by
bleeding, to two and an half or below it, fo that
the ftimulus of the mercury (hall tranfcend it. The
fafety of mercury when introduced into the fyftem
has three advantages as a ftimulus over that of the
matter which produces the fever. It excites an ac-
tion in the fyftem preternatural only in force. It
does not derange the natural order of actions. 2.
It determines the actions chiefly to external parts
of the body, and 3dly it fixes them when it affects
the mouth and throat upon parts which are capable
of bearing great inflammation and effufion without
any danger to life. The ftimulus which produces
the yellow fever acts in ways the reverfe of thofe
which have been mentioned. It produces violent
irregular or 'wrong actions. It determines them to
internal parts of the body, and it fixes them upon

I 2 vifcera

I l5 AN ACCOUNT OF THfi

vifcera which bear with difficulty and danger the
ufual effects of difeafe. A late French writer, Dr.
Fabre, afcribed to difeafes a centrifugal, and a cen-
tripetal direction. From what has been faid, it would
feem, the former belongs to mercury, and the lat-
ter to the yellow fever.

Confidering the great prejudices againfl blood-
letting, I have wifhed to combat this fever with
mercury alone. But for reafens formerly given, I
have been afraid to trull: to it without the afliftance
of the lancet. The character of the fever more-
over, like that which the poet has afcribed to
Achilles, is of " fo fwift, irritable, inexorable, and
" cruel" a nature, that it would be mifafe to rely
exclufively upon a medicine which is not only of
lefs efficacy than bleeding, but often flow, and un-
certain in its operation, more cfpccially upon the
throat and mouth.

Let not the reader be offended at my attempts
to reafon. I am aware of the evils which the
weak and perverted exercife of this power of the
mind, has introduced into medicine. But let us
acl with the fame confiftency upon this fubjeft, that
we do in other things.

BILIOUS YELLOW 1£V£R IN 1/9/. I 1 7

We do not conflgn a child to its cradle for life,
becaufe it falls in its firit unfuccefsful efforts to ufe
its legs. In like manner, we mufl not abandon rea-
fon, becaufe in our firit efforts to ufe it, we have
been deceived. A fingle juft principle in our fcience,
will lead to more truth in one year, than whole vo-
lumes of uncombined facts will do in a century.

I loft but two patients in our iate epidemic in
whom the mercury excited a falivation. One of
them died from the want of nurfing ; the other by
the late application of the remedy.

Cf VOMITS.

It was faid, a practitioner who was oppofed to
bleeding and mercury, cured this fever by means
of flrong vomits. I gave one to a man who refuf-
ed to be bled. It operated freely, and brought on
a plentiful fweat. The next day he arofe from his
bed, and went to his work. On the 4th day he
fent for me again. My foil vifited him and found
him without a pulfe. lie died the next day.

I heard of two other perfons who took emetics
in the beginning of the fever without the advice of
a phyfician, both of whom died.

Dr.

I iS AN ACCOUNT OF THE

Dr. Pinkard informed me that their effe&s were
generally hurtful in the violent grades of the yellow
fever in the Wed Indies — The fame information
has llnce been given to me by Dr. Jackfon. In the
2d and 3d grades of the bilious fever, they ap-
pear not only to be fafe, but ufeful.

Of DIET and DRINKS.

The advantages of a weak vegetable diet were
very great in this fever. I found but little difficulty
in mod cafes in having my prohibition of animal food
complied with before the crifis of the fever, but
there was often fuch a fudden excitement of the
appetite for it, immediately afterwards, that it was
difficult to reftrain it. 1 have mentioned the cafe
of a young man who was upon the recovery, who
died in confequence of fupping upon beef-flakes.
Many other inilances of the mortality of this fever
from a fimiiar caufe, I believe, occurred in our epi-
demic, which were concealed from our phyficians.
I am not fingular in afcribing the death of convale-
fcents to the too early ufe of animal food. Dr.
PoilTonnier has the following important remark up-
on this fubjecl. " The phyficians of Brefl have
obferved, that the relapfes in the malignant fever
which prevailed in their naval hofpitals, were as

much

BILIOUS YELLOW FEVER IN 1797. I 19

much the efFect of a fault in the diet of the fick as of
the contagious air to which they were expofed, and
that as many patients perifhed from this caufe, as
from the original fever. For this reafon light lbups,
with leguminous vegetables in them, panada, rice
feafoned with cinnamon, frefh eggs, &:c. are all
that they mould be permitted to eat. The ufe of
flefh fhould be forbidden for many days after the
entire cure of the diforder."*

Dr. Huxham has furnifhed another evidence of
the danger from the premature ufe of animal food,
in his hiftory of a malignant fever which prevailed
at Plymouth in the year 1740. " If any one (Tays
the doctor) made ufe of a flefh, or fiili diet, before
he had been very well purged, and his recovery
confirmed, he infallibly indulged himfelf herein at
the utmofl danger of his life."f

In addition to the mild articles of diet, mention-
ed by Dr. PoiiTonnier, I found bread and milk with
a little water, fugar, and the pulp of a roafled ap-
ple mixed with it, very acceptable to my patients
during their convalefcence. Oyflqrs were equally
innocent, and agreeable. Ripe grapes were de-
voured

* Maladies de gens de mer, vol. 1. p. 34.5.
\- Epidemics, vol. 11. p. 6-j-.

*20 AN ACCOUNT OF THE

voured by them with avidity, in every ftagc of the
fever. The feafen had been favourable to the per-
fection of this pleafant fruit, and all the gardens
in the city and neighbourhood in which it was cul-
tivated, were gratuitouily opened by the citizens
for the benefit of the fick.

The drinks were, co!d water, toaft and water,
balm tea, water in which gellies of different kinds
had been diffclved, lemonade, apple water, barley
and rice water, and in cafes where the ftomach was
affected with ficknefs, or puking, weak porter and
water, and cold camomile tea. In the convalefcent
ilage of the fever, and in fuch of its remiffions or
intermiffions, as were accompanied with great lan-
guor in the pulfe, wine-whey, porter and water, and
brandy and water, were taken with advantage.

Cold water applied to the body, cool and frefh
air, and cleanlinefs. produced their ufual good effects
in this fever. In the external ufe of cold water,
care was taken to confine it to fuch cafes as were
accompanied with preternatural heat, and to forbid
it in the cold fit of the fever and in thofe cafes
which were attended with cold hands and feet, and
where the difeafe fhewed a difpofition to terminate
in its firfl ilage, by a profufe perfpiration. It has
lately given me great pleafure to find the fame prac-
tice

BILIOUS YELLOW FEVER IN 1797. 121

tice in the external ufe of cold water in fevers, re-
commended by Dr. Currie of Liverpool in his me-
dical reports of the effects of water, cold and
warm, as a remedy in febrile difeafes. Of the be-
nefit of frefh air in this fever, Dr. Dawfon of Tor-
tola has lately furnifhed me with a ftriking inflance.
He informed me that by removing patients from the
low grounds on that ifland, where the tcvcr is gene-
rated, to a neighbouring mountain, they generally
recovered in a few days.

Finding a difagreeable fmell to arife from vinegar
fprinkled upon the floor after it had emitted all its
acid vapor, I directed the floors of fick rooms to be
fprinkled only with water. I found the vapor
which arofe from it to be grateful to my patients.
A citizen of Philadelphia whofe whole family reco-
vered from the fever, thought he perceived evident
advantages from tubs of frefh water being kept con-
ftantly in the fick rooms.

Of TONIC REMEDIES.

There were now and then remuTions and inter-
miflions of the fever accompanied with fuch figns of
danger from debility, as to render the exhibition
of a few drops of laudanum, a little wine-whey, a

glafc

122 AN ACCOUNT OF THE

glafs of brandy and water, and in fome inftances a
cup of weak chicken-broth highly neceffary and
ufefuL In addition to thefe cordial drinks, I direct-
ed the feet to be placed in a tub of warm water
which was introduced under the bed clothes, fo
that the patient was not weakened by being raifed
from a horizontal pofture. All thefe remedies were
laid afide upon the return of a paroxyfm of fever.

I did not prefcribe bark in a fingle cafe of this
difeafe. An infufion of the quaffia root was fub-
flituted in its room in feveral inftances with advan-
tage.

Blisters were applied as ufual, but from the
jnfenfibility of the ikin, they were lefs effectual
than applications of muftard to the arms and legs.
It is a circumftance worthy of notice, that while
the flomach, bowels, and even the large blood-
veffels, are fometimes in a highly excited ftate, and
overcharged as it were with life, the whole furface
of the body is in a ftate of the greateft torpor.
To attempt to excite it by internal remedies is like
adding fuel to a chimney already on fire. The ex-
citement of the blood-veffels, and the circulation of
the blood, can only be equalized by the application of
flimulants to the ikin. Thefe, to be effectual, mould
be of the mod powerful kind. Candies might

probably

BILIOUS YELLOW FEVER IN 1 79/. 1 23

probably be ufcd in fuch cafes with advantage,
I am led to this opinion by a fact communicated to
me by Dr. Stewart. A lighted candle which had
been left on the bed of a woman whom he was at-
tending in the apparent lad flage of the yellow fe-
v^r, fell upon her bread. She was too infenfible
to feel, or too weak to remove it. Before her
nurfe came into her room, it had made a deep and
extenfive impreflion upon her flefh. From that
time fhe revived, and in the courfe of a few days
recovered. As a tonic remedy in this fever, Dr.
Jackfon has fpoken to me in high terms of the good
effec"b of riding in a carriage. Patients, he inform-
ed me, who were moved with difficulty, after riding
a few miles, were able to fit up, and when they re-
turned from their excurfions, were frequently able to
walk to their beds.

Much has been faid of late years in favor of the
application of warm olive oil to the body in the plague,
and a wifli has been expreffed by fome people that
its efficacy might be'tried in the yellow fever. Up-
on examining the account of this remedy as publish-
ed by Mr. Baldwin, two things fugged themfelves
to our notice.

1. That the oil is effe&ual only in t\\tfor?ning (late
of the difeafe, and 2dly, that it acts chiefly by deplet-
ing from the pores of the body. From the unity of

the

3 24 AN ACCOUNT OF THE

the remedy of depletion, it is probable, purging or
bleeding might be fubftifuted to the expenfive parade
of the fweat induced by the warm oil, and the fmoke
of odoriferous vegetables. But I mult not conceal
here, that there are facts which favour an idea, that
oil produces a fedative action upon the blood-vefTels
through the medium of the fkin. The Africans,
and the American Indians, protect themfelves from
fevers in the mod fickly fituations, by anointing their
bodies with oil. Bontius fays, the fame application
is ufed in the Eaft Indies, for the cure of malignant
fevers, afrer the previous ufe of bleeding and purg-
ing. It feems to have been a remedy well known
among the Jews, hence we find the apoftle James
advifes its being applied to the body, in addition to
the prayers of the elders of the church.* It is thus
Sn other cafes, the bleffings of heaven are conveyed
to men through the ufe of natural means.

I have wiihed the effects of irTues to be tried among
the prophylactic remedies of. the yellow fever.
They have prevented the plague in many hundred in-
stances, according to Parifmus, Florentinus, Foreflus
;:nd ievera! other authors quoted by Diemerbroeck.i
Paraeus fays that all who had ulcers from the vene-
real difeafe, or any other caufe, efcaped it. Br.
Hodges owed his prefervation from ficknefs and

death
* Chapter v. verfe 14. f De Pefte, p. j.03.

BILIOUS YELLOW TEVER IN 1797. 125

llcath in the hid plague in London, to an iiTue in his
ley. He tells us that it always gave him fome pain
when he was expofed to the contagion, in vifiting
his patients. The peftilential matter was probably
attracted by the artificial weak part in his leg, and
thus thrown out of his fyftem.

During the existence of the premonitory fymptoms#
and before patients were confined to their rooms, a
gentle purge, or the lofs of a few ounces of blood,
in many hundred inftances prevented the formation
of the fever. I did not meet with a fingle exception
to this remark.

Fevers are the affliction chiefly of poor people.
To prevent, or to cure them, remedies muft be cheap,
and capable of being applied with but little attend-
ance. From the affinity eftablifhed by the creator
between evil and its antidotes in other parts of his
works, I am difpofed to believe no remedy will ever
be effectual in any general difeafe, that is not cheap*
and that cannot eafily be made univerfal.

It is to be lamented that the greateft part of all the
deaths which occur, are from difeafes that are under
the power of medicine. To prevent their fatal ifTue,
it would feem to be agreeable to the order of heaven
in other things, that they fliould be attacked in

their

126 AN ACCOUNT OF THE

their forming date. Weeds, vermin, public oppref-
lion, and private vice, are eafily eradicated and de-
ftroyed, if oppofed by their proper remedies, as foon
as they fhow themfelves. The principal obftacle to
the fuccefsful ufe of the antidotes of malignant fevers
in their early ftage arifes from phyficians refufmg to
declare when they appear in a city, and from their
practice of calling their mild forms, by other names
than that of a mortal epidemic. If every record of
the hiftory of man were deflroyed, and this inftance
only of the conduct of phyficians preferved, it would
be fufficient to eftablifh the depraved character of
our fpecies. Tyrants opprefs, and heroes butch-
er their fellow creatures for plunder and fame, but
phyficians who conceal the exiflence, or deny the
real names of peflilential difeafes, often become the
means of deftroying the lives of thoufands, without
deriving any material benefit from their inhuman con-
duct.

I mail now fay a few words upon the fuccefs of
the depleting practice in our late epidemic.

From the more malignant flate of the fever, and
from the fears and prejudices that were excited
againft bleeding and mercury by means of the news-
papers, the fuccefs of thofe remedies was much
lefs than in the years 1793 and 1794. Hundreds

refufed

BILIOUS YELLOW FEVER IN 1797. I27

refuted to fubmit to them at the time, and in the
manner that were neceffary to render them effectual.
From the publications of a number of phyficians
who ufcd the lancet and mercury in their greateft
extent, it appears that they loft but one in ten of
all they attended. It was faid of feveral practition-
ers who were oppofed to copious bleeding, that
they loll a much fmaller proportion of their pa-
tients with the prevailing fever. Upon inquiry, it
appeared they had loft many more. To conceal
their want of fuccefs, they faid their patients had
died of other difeafes. This mode of deceiving the
public began in 1793. The men who ufed it, did
not recollect, that it is lefs in favour of a phyfician's
fkill to lofe patients in pleurifies, colics, hcemcrrha-
gies, contufions, and common remittents, than in
a malignant yellow fever.

Dr. Sayre attended fifteen patients in the difeafe,
all of whom recovered by the plentiful ufe of the
depleting remedies. His place of refidence being
remote from thofe parts of the city in which the
fever prevailed mod, prevented his being called to
a greater number of cafes.

A French phyfician who bled and purged mode-
rately, candidly acknowledged that lie faved but
three out of four of his patients.

120 AN ACCOUNT Of THE

In the city hofpital, where bleeding was fparifig-
ly ufed, and where the phyficians depended chiefly
upon a falivation ; more than one half died of all
the patients who were admitted. It is an act of
juftice to the phyficians of the hofpital to add, that
many, perhaps mod of their patients were admitted
after the firfr. day of the difeafe.

I cannot conclude this comparative view of the
fuccefs of the different modes of treating the yello\T
fever, without taking notice that the Simulating
mode, as recommended by Dr. Kuhn and Dr. Ste-
vens in the year 1793, was deferted by every phyfi-
cian in the city. Dr. Stevens, with a candor which
does honor to his integrity, acknowledged the dif-
eafeto require a different treatment from that which
it required in the Weft Indies ; and feveral other
phyficians who had written againft bleeding and mer-
cury, or who had doubted of their fafety and effi-
cacy in 1793, ufed them with confidence, and in
the moft liberal manner, in 1797. It was remark-
able that the phyficians who ufed thofe remedies
more fparingly, reprobated in the fame language
the lofs of ten ounces of blood in the fever of 1793,
that they did the lofs of 100 in the fever cf the
lad year. They forgot likewife in their ufe of iod
or 200 grains of mercury to excite a falivation,
their former execrations of Dr. Young's fafe and

fimplc

BILIOUS YELLOW FEVER IN 1 797.

129

fimple purge of ten grains of jalap, and ten of
calomel.

In the hiftories I have given of the yellow fe-
vers of 1793 and 1794, I have fcattered here and
there, a few obfervations upon their degrees of
danger, and the figns of their favourable and un-
favourable ifTue. I mall clofe the prefent hiftory,
by cohering thofe obfervations into one view, and
adding to them fuch other figns as have occurred to
me in obferving our late epidemic.

Signs of moderate danger, and a favourable iffue
of the yellow fever.

1. A chilly fit accompanying the attack of the
fever. The longer this chill continues, the more
favourable the difeafe.

2. The recurrence of chills every day, or twice a-
day, or every other day, with the return of the exa-
cerbations of the fever. A coldnefs of the whole body
at the above periods without chills, a coldnefs with a
profufe fweat, cold feet and hands with febrile heat in
other parts of the body, and a profufe fweat without
chills, or coldnefs, are all lefs favourable fymptoms
than a regular chilly fit, but they indicate lefs danger
than their total abfence during the courfe of the fever.

•■■ *.

X30 AN ACCOUNT OF THE

3. A puking of green or yellow bile on the firfl
day of the difeafe is favourable. A difcharge of
black bile, if it occur on the first day of the fever,
is not unfavourable.

4. A difcharge of green and yellow flools. It
is more favourable if the flools are of a dark or
black colour, and of a foetid and acrid nature, on
the firfl: or fecond day of the fever.

5. A foftnefs and moiflure on the ikin, in the
beginning of the fever.

6. A fenfe of pain in the head, or a hidden
tranflation of pain from internal to external parts
of the body, particularly to the back. An in-
creafe of pain after bleeding.

7. A fore mouth.

8. A white or a yellow tongue.

9. An early difpofition to fpit freely, whether
excited by nature, or the ufe of mercury.

10. Blood becoming iizy, after having exhibited
the ufual marks of great morbid action in the blood-
veffels.

11. Great

BILIOUS YELLOW FEVER IN 1 797. 1 3

1 >

11. Great and cxquifite fenfibility in the fenfe of
'eeling coming on near the clofe of the fever.

Signs of great danger, and of an unfavourable
flue of the yellow fever.

1. An attack of the fever, fuddenly fucceeding
great terror, anger, or the intemperate life of ve-
il ery.

2. The firft paroxyfm coming on without any
premonitory fymptoms, or a chilly fit.

3. A coldnefs over the whole body without chills
for two or three days.

4. A fleepinefs on the firfl and fecond days of
the fever.

5. Uncommon palenefs of the face not induced
by blood-letting.

6. Conflant, or violent vomiting without any
difcharge of bile.

7. Obftinate coftivenefs, or a difcharge of natu-
ral, or white (tools.

8. A

132 AN ACCOUNT OF THE

8. A diarrhoea towards the clofe of the fever.
I loft two patients in 1797 with this fymptom who
had exhibited a few days before, figns of a reco-
very. Dr. Pinkard informed me that it was gene-
rally attended with a fatal iffue in the yellow fever
of the Weft Indies. t)iemerbroeck declares, that
" fcarcely one in an hundred recovered, with this
fymptom, from the plague." #

9. A fuppreilion of urine. It is moil alarming
when it is without pain.

10. A difcharge of dark coloured and bloody
urine.

11. A cold, cool, dry, fmooth, or fhining ikin.

12. The appearance of a yellow colour in the
face on the firft or fecond day of the fever,

13. The abfence of pain or a fudden celfation of
it, with the common fymptoms of great danger.

14. A difpofition to faint upon a little motion,
and fainting after lofing but a few ounces of blood.

* Lib. 1. cap. x^.

BILIOUS YELLOW FEVER IN 1797. *33

15. A watery, glaffy, or brilliant eye. A red
eye on the 4th or 5th day of the difeafe. It is
more alarming if it become fo after having been
previoufly yellow.

16. Imperfect vifion, and blindnefs in the clofe
of the difeafe.

17. Deafne'fs.

1 8. A preternatural appetite, more efpecially in
the lafl flage of the fever.

19. A flow, intermitting, and fhattered pulfe.

20. Great reftleffnefs, delirium and long conti-
nued coma.

21. A difcharge of coffee-coloured, or black bile
from the itomach after the 4th day of the fever.

I mall conclude this head by the following re-
marks.

1. The violence, danger, and probable iflue of
this fever, feem to be in proportion to the duration
and force of the predifpofing and exciting caufes.
However fteady the former "are in bringing on debi-
lity,

!^4 •---' ACCODNT OF T

lity, and the btl itimulants upon ac-

cumulated exc: : a knowledge of their

duration and : ufeful, not only in

forming an opinion of the probable HTue of the
fever, but in regulating the force of remedies.

2. The figns of danger vary in different years
m the infmer. eather upon the difeafe.

Nottrithftanding the figns of the favourable
and unfavourable iffue of the fever, are in general
uniform when the cure of the dife limit ted

to nature, or to tonic medicines, yet they are far
from bem* fo when the treatment of the fever is
co oat of the hai ature, and attempted

by the uie of & ig remedies. We often fee

patients r with nearly all the unfavourable

fymptoms that have been mentioned, and we fome-
times fee them die, with all thofe that are favour-
able. The words Gf M therefore which he
cd to the plague, are equally true, when
applied to the yellow iV. er. '; In the plague our
fenfes deceive us. R The
aphorifms cf Hippocrates deceive us."* An im-
portant

ttrt2 -rxdiQac:.

BILIOUS YELLOW FEVER IN 1 797- 135

jiortant lcffon may be learned from thefe fa&s, and
that is, never to give a patient over. On the con-
trary, it is our duty in this, as well as in all other
acute difeafes, to difpute every inch of ground with
death. By means of this practice which is war-
ranted by fcience, as well as dictated by humanity,
the grave has often been deprived for a while of its
prev, and a prelude thereby exhibited of that ap-
proaching and delightful time foretold by ancient
prophets, when the power of medicine over dif-
eafes fhall be fuch, as to render old age the on-
ly outlet of human life.

OBSERVATIONS

UPON THE

NATURE AND CURE

OF THE

GOUT

OBSERVATIONS, <&V

J_ N treating upon the gout, I (hall deliver a few
preliminary proportions.

i. The gout is a difeafe of the whole fyftem. It
aifecls the ligaments, blood-veffcls, flomach, bowels,
brain, liver, lymphatics, nerves, mufcles, cartila-
ges, bones and ikin.

2. The gout is a primary difeafe, only of the fo-
lids. Chalk-fiones, abfeeffes, dropfcal eftufions into
cavities, and cellular membrane, and eruptions on
the ikin, are ail the eiTecls of a morbid action in the
blood-veiTels. The truth of this propofition has
been ably proved by Dr. Cullen in his firft lines.

3- &

14© OBSERVATIONS ON

3. It affe&s moil frequently perfons of a fanguine-
ous temperament ; but fometimes it affects perfons
of nervous, and phlegmatic temperaments. The
idle and luxurious are more fubject to it, than the
labouring and temperate part of mankind. Women
are faid to be lefs fubject to it than men. 1 once
believed, and taught this opinion, but I now retract
it. From the peculiar delicacy of the female confli-
tution, and from the thin covering they wear on-
their feet, and limbs, the%out is lefs apt to fall up-
on thofc parts than in men, but they exhibit all its
other fymptoms, perhaps more frequently than men,
in oilier parts of the body. The remote caufes of
gout moreover to be mentioned prefently, act: with
equal force upon both fexes, and more of them I be-
lieve upon women than upon men.

It generally attacks in thofe periods of life, and in
thofe countries, and feafons of the year, in which in-
flammatory difeafes arc moft common. Jt feldom affects
perfons before puberty, or in old age, and yet I
have heard of its appearing with all its moft charac-
terise fymptoms in this city in a child of 6, and in a
man abo\ e cc rears of age. Men of active minds are
faid to be moft fubjecl: to it, but 1 think I have (ccn
it as frequently in perfons of {lender and torpid in-
tellects, as in perfons of an oppofite character. I have
h.urd of a cafe of gout in an Indian at Pittfburgh, and

I have

THE GOUT. 141

have cured a fit of it in an Indian in this city. They
had both been intemperate in the life of wine and
fermented liquors.

4. It is in one refpect. an hereditary difeafe depend-
ing upon the propagation of a fimilar temperament
from father to ion. When a predifpofition to the
gout has been derived from anceftors, lefs force in ex-
citing caufes will induce it than in thofe habits where
this has not been the cafe. This predifpofition
fometimes pafTes by children, and appears in grand-
children. There are inftances likewife in which it
has paifed by the males, and appeared only in the
females of a family. It even appears in the defend-
ants of families who have been reduced to poverty,
but not often where they have been obliged to labour
for a fubfiflence. It generally pafTes by thofe chil-
dren who are born before the gout makes its appear-
ance in a father. It is curious to obferve, how exten-
iively the predifpofition pervades fome families. An
Englifh gentleman who had been afHi&ed with the
gout married a young woman in Philadelphia many
years ago, by whom he had one daughter. His wife
dying three weeks after the birth of this child, he
returned to England, where he married a fecond
wife, by whom he had fix children, all of whom except
one died with the gout before they attained to the
ufual age of matrimony in Great Britain. One of

them

142 OBSERVATIONS ON

them died in her 16th year. Finally the father and
grand-father died with the fame diibrder. The
daughter whom this afflicted gentleman left in this
city, paiTed her life fubject to the gout, and finally
died under my care in the year 1789 in the 68th year
cf her age. She left a family of children, two of
whom have had the gout. One of them, a lady,
has fuffered exquiiitely from it.

5. The gout is always induced by general predif-
pcfing direct or indirect debility.

6. The remote caufes of the gout which induce
this debility, are, indolence, great bodily labour,
long protracted bodily exercife, intemperance in eat-
ing, and in venery, acid aliments and drinks, flrong
tea and coffee, public and domeftic vexation, the
violent, or. long continued exercife of the under-
ftanding, imagination and pailions in fludy, bufmefs
or pleafure, and laflly, the ufe of ardent, and fer-
mented liquors. The laft are abfolutely neceffary
to produce that form of gout which appears in the
ligaments and mufcles. I affert this, not only from
my own obfervations, but from thofe of Dr. Cado-
gan, and Dr. Darwin, who fay they never faw a
cafe of gout in the limbs in any perfon who had
not ufed fpirits or wine in a greater or lefs quan-
tity. Perhaps this may be another reafon why wo-
men*

THE GOUT. I43

men, who drink lefs of thofe liquors than men, are
fo rarely affected with this difeafe in the extreme
parts of their bodies. Wines of all kinds are
more difpofed to produce this form of gout than
fpirits. The reafon of this mufl be refolved into
the lefs ftimulus in the former, than in the latter
liquors. Wine appears to referable in its action
upon the body, the moderate ftimulus of miafmata
which produce a common remitting fever, or inter-
mitting fever, while fpirits refemble that violent ac-
tion induced by miafmata which pafTes by the blood-
veffels, ligaments and mufcles, and invades at once
the liver, bowels and brain. There is one fymp-
tom of the gout in the extremities which feems to
be produced exclufively by ardent fpirits, and that is
a burning in the palms of the hands, and foles of
the feet. This is fo uniform, that I have fometimes
been able to convict my patients of intemperance in
the ufe of fpirits, when no other mark of their
having taken them in exccfs, appeared in the fy-
ftem.

7. The exciting caufes of the gout are frequently
a greater degree, or a fudden application of its re-
mote and predifpofing caufes. They act upon the
accumulated excitability of the fyftem, and by de-
flroying its equilibrium of excitement, and regular
order of actions, produce convulfion, or irregular

morbid

144 OBSERVATIONS ON

morbid and local excitement. Thefe exciting caufel
are either of a ftimulating, or of a fedative nature.
The former are violent exercife, of body or mind,
night-watching, and even fitting up late at night*
a hearty meal, a fit of drunkennefs, a few glaffes
of claret or a draught of cyder, where thofe liquors
have not been habitual to the patient, a hidden pa-
roxyfm of joy, anger, or terror, a diflocation of a
bone, {training of a joint, particularly of the an-
kle, undue prefTure upon the foot, or leg, from a
tight fhoe or boot, an irritated corn, and the ufual
remote caufes of fever. The latter exciting caufes,
are fudden inanition from bleeding, purging, vo-
miting and fading. Cold, fear, grief, excefs in
venery, and the debility left upon the fyitem by
the crifis of a fever. All thefe caufes aft more
certainly when they are aided by the additional
debility induced upon the fyftem in ileep. It is
for this reafon that the gout generally makes its firfl
attack in the middle of the night, and in a part of
the fyflem moft remote from the action of the heart,
and the energy of the brain, viz. in the great toe,
or in fome part of the foot. — In afcribing a fit
of the gout to a caufe which is of a fedative nature,
the reader will not fuppofe that I have departed
from the fimplicity and uniformity of a proposition,
I have elfewhere delivered,* that difeafe is the ef-
fect

* Medical Inquiries and Obfervations, vol. it.

'•?HE GOUT. I45

left of ftimulus. The abftraftion of a natural and
habitual impreflion of any kind, by increafmg the
force of thoie which remain, renders the producti-
on of morbid, and exceflive aftions in the fyftem as
much the efFeft of preternatural or difproportioned
ftimulus, as if they were induced by caufes that
are externally and evidently flimulating. It is thus
in many other of the operations of nature, oppofite
caufes produce the fame effects.

8. The proximate caufe of the gout as of all other
difcafes, is morbid excitement, accompanied with
irregular action, or the abfence of all action from
the force of ftimulus. There is nothing fpecific in
the morbid excitement and aftions which take place
in the gout different from what occur in fevers.
However varied morbid aftions may be by their
caufes, feats, and effefts, they are all of the fame,
and the time will probably come when the whole
nomenclature of morbid aftions will be abforbed in
the fmgle name of difeafe.

I ftiall now briefly enumerate the fymptoms of the
gout as they appear in the ligaments, the blood-
veffels, the vifcera, the nervous fyftem, the alimen-
tary canal, the lymphatics, the lkin, and the bone?
of the human body.

L The

I46 OBSERVATIONS ON

I. The ligaments which connect the bones are
the feats, of what is called a legitimate or true
gout. They are affected with pain, fwelling, and
inflammation. The pain is fometimes fo acute as to
be compared to the gnawing of a dog. We per-
ceive here the famenefs of the gout with the rheu-
matifm. Many pages, and indeed whole effays
have been compofed by writers to diflinguifh them,
but they are exactly the fame difeafe while the mor-
bid actions are confined to this part of the body.
They are it is true produced by different remote
caufes, but this conftitutes no more difference in
their nature, than is produced in a coal of fire whe-
ther it be inflamed by a candle, or by a fpark of
electricity. The morbid actions which are induced
by the ufual caufes of rheumatifm affect, though
lefs frequently, the lungs, the trachea, the head,
the bowels, and even the heart, as well as the gout.
Thofe actions, moreover, are the means of a fluid
being effufed which is changed into calcarious mat-
ter in the joints and other parts of the body ex-
actly like that which is produced by the gout. They
likewife twift and diflocate the bones in common
with the gout, in a manner to be defcribed here-
after. The only difference between what are called
gouty, and rheumatic actions, confifts in their feats
and in the degrees of their force. The debility
which predifpofes to the gout, being greater, and

THE GOUT. 147

more extenfively diffufed through the body than
the debility which precedes rhcuraatifm, the mor-
bid anions in the former cafe, pafs more readily
from external to internal parts, and produce in both,
more acute and more dangerous effects. A fimile
derived from the difference in the dsgrees of action
produced in the fyftem by marlh miafmata, made
ufe of upon a former occafion, will ferve me again
to illuftrate this part of our fubject. A mild re-
mittent, and a yellow fever are different grades of
the fame difeafe. The former, like the rheuma-
tifm, affects the bones chiefly with pain, while the
latter, like the gout, affects not only the bones,
but the ftomach, bowels, brain, nerves, lympha-
tics, and all the internal parts of the body,

II. In the arterial fyftem the gout produces fe-
ver. This fever appears not only in the increafed
force or frequency of the pulfe, but in morbid
affections of all the vifcera. It puts on all the dif-
ferent grades of fever from the malignity of the
plague, to the mildnefs of a common intermittent.
It has moreover its regular exacerbations and remif-
fions once in every four and twenty hours, and its
crifis ufually on the 14th day in violent cafes. In
moderate attacks, it runs on from 20 to 40 days in
common with the typhus or flow chronic ftate of
fever. It is common for thofc perfons who confider

the

OBSERVATIONS ON

the gout as a fpecific difeafe, when it appears iff
the above forms, to fay, that it is complicated with
fever ; but this is an error, for there can exiil but
one morbid action in the blood-veffels at once, and
the fame laws are impofed upon the morbid actions
excited in thofe parts of the body by the remote
caufes of the gout3 as by the common caufes of
fever. I have feen two inflances of this difeafe ap-
pearing in the form of a genuine he<ftic, and one
in which it appeared to yield to lunar influence in
the manner defcribed by Dr. Balfour. * In the
highly inflammatory ftate of the gout the fenfibility
of the blood-velTels far exceeds what is feen in the
fame ftate of fever from more common caufes. I
have known an inftance in which a tranflation of
the gouty action to the eye produced fuch an ex-

quifite

:1. Diemerbroeck has the following remark upon it in
his treatife upon the plague in Holland, lib. i. cap. v.
" Duobus tribufVe diebus, ante et poll novilunium, ut et
" plenilunium, haec dira lues fjmper e::acerbata fuit, ecque
u tempore, et plurimos morbos corripiebat, et quos tunc in-
<; vadebat, illi fere omnes moriebantur." Dr. Pinkard in-
formed me that he had obferved perfons in Demerara to be
more dlipoied to attacks, and relapfes of fever, within the
lunar periods than at any other time. From fome facts that
have lately come to my knowledge, I am fatisned the influ-
ence of the full and new moon, is fenfibly felt in the fevers
of Philadelphia..

THE GOUT. I49

quifite degree of fenfibility, that the patient was
unable to bear the feeble light which was emitted
from a few coals of fire in his room, at a time too
n the coldnefs of the weather would have made
a large fire agreeable to him. It is from the ex-
treme fenfibility which the gout imparts to the flo-
mach that the bark is fo generally rejected by it.
I knew a Britifh officer who had nearly died from
taking a fpoonful of the infufion of that medicine
while his arterial fyftem was in this ft ate of morbid
excitability from a fie of the gout. It is remark-
able that the gout is mod difpofed to affume a ma-
lignant character during the prevalence of an in-
flammatory conflitution of the atmofphere. This
has been long ago remarked by Dr. Huxham.
Several inftances of it have occurred in this city
fince the year 1793.

III. The gout affects moil of the vifcera. In
the brain it produces head-ach, vertigo, coma, apo-
plexy, and palfy. In the lungs it produces pneu-
monia vera, notha, aflhma, haemoptyfis, pulmona-
ry confumption, and a fhcrt becking cough, firft de-
fcribed by Dr. Sydenham. In the throat it pro-
duces inflammatory angina. It affects the kidneys
with inflammation, ftrangury, diabetes and calculi.
The pofition of the body for weeks or months on
the back, by favouring the comprefSon of the kid-
neys

*5° OBSERVATIONS ON

oeys by the bowels, is the principal rcafon why
thofe parts fuffer fo much in gouty people. The
flrangury appears to be produced by the fame kind
of engorgement or choking of the veffels of the
kidneys, which takes place in the fmall-pox and
yellow fever. Four cafes of it are defcribed in the
3d volume of the Phyfical and Literary Effays of
Edinburgh, by Dr. David Clerk. I have feen one in-
fiance cf death in an old man from this caufe. The
catheter brought no water from his bladder. The
late Mr. John Penn formerly governor of Pennfyl-
vania, I have been informed by one of his phyfi-
cians, died from a fimilar affection in his kidneys
from gout. The catheter was as ineffectual in giv-
ing him relief, as it was in the cafe of my patient.
The neck of the bladder fometimes becomes the feat
of the gout. It difcovers itfelf by fpafm, and a
fuppreffion of urine in fome cafes, and occafionally
by an habitual difcharge of mucus through the ure-
thra. This diforder has been called by Lieuteaud,
cc a catarrh of the bladder." But of all the vif-
cera, the liver fuffers moft from the gout. It pro-
duces in it inflammation, fuppuration, meiena, fchir-
rus, gaii-frcnes, jaundice, and an habitual increafed
fecretion and excretion of bile. Thefe diforders- in
the liver appear molt frequently in fouthern coun-
tries, and in female habits. They are fubflitutes
for a gout in the ligaments, and in the extremities

THE GOUT. I5I

of the body. They appear likewife in drunkards
from ardent fpiriis. It would feem that certain fli-
rnuli act fpecifically upon the liver, probably for the
wife purpoic of difcharging fuch parts of the blood
from the body, as are vitiated by the rapidity of
its circulation. I have in a former publication, *
taken notice of the action of marfli miafmata upon
the livers of men and beads. It has been obferved
that hogs that live near brewhoufes, and feed upon
the fermented grains of barley, always difcovcr en-
larged or difeafed livers. But a determination of
the blood to the liver, and an incrcafed action of
its veflels, are produced by other caufes than marfli
miafmata, and fermented and diftillcd liquors. They
appear in the fever which accompanies madnefs
and the malignant fore-threat, alfo in contufions of
the brain, and in the excited ftate of the blood-
vcffels which is produced by anger and exercife.
1 have found an attention to thefe facts ufeful in
prefcribing for difeafes of the liver, inafinuch as
they have led me from confidering them as idiopa-
thic affections, but as ilic effects only of morbid ac-
tions excited in other parts of the body.

IV. The gout fbmetimes affe&s the arterial, and
nervous fyftems jointly, producing in the brain9

coma,

* Medical Inquiries and Obfervations, vol. iv.

IJ2 OBSERVATIONS ON

coma, vertigo, apoplexy, palfy, lofs of memory,
and macinefs, and in the , hyfteria, hypocon-

driafis, and fyncope. It is common to fay the gout
counterfeits all thefe difeafes. But this is an in-
accurate mode oi fpeaking. All thofe difeafes have
but one proximate caufe, and they are exactly the
fame, however different the flimulus may be, from
which they are derived. Sometimes the gout af
the brain and nerves exclufively, without producing
the lead morbid action in the blood-veiTels. I once
amended a gentleman from Barbadoes who differed
1 this affection of his brain and nerves, the mod
intolerable depreihon of fpirits. It yielded to large
dofes of wine, but his relief was perfect, and more
durable, when a pain was excited by nature or art,
hands or feet.

The mufcles are fometimes affected by the gout
with fpafm, with general and partial convulfions,
and laftly with great pain. The angina pectoris,
or a fudden inability to breathe after climbing a hill,
or a pair of flairs, and after a long walk, is fome-
times a fymptom of the gout. There is a pain
which faddeniy pervades the head, bread and limbs,
which : an eleciric fhock. I have known

two inftances of it in gz~:y patients, and have
d the liberty of calling it the " aura^arthritica."
But • affects the mufcles is often of

THE GOUT. I$$

a more permanent nature. It is felt with moil fe-
verity in the calves of the legs. Sometimes it
affects the mufcles of the head, bread: and limbs,
exciting in them large and diflrefling fwcllings. But
further ; the gout in fome cafes feizes upon the
tendons, and twifts them in fuch a manner as to
diflocate bones in the hands and feet. It even af-
fects the cartilages. Of this I once faw an inftance
in Col. Adams of the (late of Maryland. The ex-
ternal parts of both his ears were fo much inflamed
in a fit of the gout, that he was unable to lie on
either of his fides.

V. The gout affects the alimentary canal from
the ftomach, to its termination in the rectum.
Flatulency, ficknefs, indigeftion, pain, or vomiting,
ufually ufher in a fit of the difeale. The fick head-
ach, alfo dyfpepfia* with all its train of diflreiTing
evils, are frequently the effects of gout concentrat-
ed in the ftomach. I have feen a cafe in which the
gout, by retreating to this vifcus, produced the fame
burning fenfation which is felt in the yellow fever.
The patient who was the fubject of this fymptom
died two days afterwards with a black vomiting.
It was Mr. Patterfon, formerly collector of the
port of Philadelphia, under the Britifh government.
I was not furprifed at thefe two uncommon fymp-
toms in the gout, for I had long been familiar with

M its

154 OBSERVATIONS ON

its difpofition to affect the biliary fecretion, and the
actions of the flomach. The colic and dyfentery,
are often produced by the gout in the bowels. In
the fouthern dates of America it often produces a
chronic diarrhoea, which is known in fome places
by the name of the " downward confumption."
The piles are a common fymptom of gout, and
where they pour forth blood occafionally render it a
harmlefs difeafe. I have known an inftance in which
a gouty pain in the rectum produced involuntary
flools in a gentleman in this city, and I have heard
from a fouthern gentleman who had been afflicted
with gouty fymptoms, that a fimilar pain was ex-
cited in the fame part to fuch a degree, whenever
he went into a crouded room lighted by candles, as
to oblige him to leave it. In confidering the effects
of the gout upon this part, I am led to take notice
of a troublefome itching in the anus which has
been defcribed by Dr. Lettfom, and juftly attribut-
ed by him to this difeafe. # I have known fevcral
cafes of it. They always occurred in gouty habits.

Of the above morbid affections of the nerves,
ftomach and bowels, the hyfteria, the fick head-
ach, and the colic, appear much oftener in women
than in men. I have faid that dyfpepfia is a fymp-
tom

* Medical Memoirs, vol. iii.

THE GOUT. I'55

tern cf gout. Out of more than 500 perfons who
were the patients of the Liverpool infirmary and
difpenfary in one year, Dr. Currie informs u&9
" a great majority were females. V t

VI. The gout affects the glands and lymphatics.
It produced a falivation of a profuie nature in
Major Pearce Butler, which continued for two days.
It produced a bubo in the groin in a citizen of Phi-
ladelphia. He had never been infected with the
venereal difeafe, of courfe no fufpicion was enter-
tained by me of its being derived from that caufe.
I knew a lady who had periodical fwellings in her
breads, at the fame feafon of the year in which
fhe had before been accuftomed to have a regular
fit of the gout. The fcrophula and all the forms of
dropfy are the effects in many cafes of the difpofi-
tion of the gout to attack the lymphatic fyftem.
There is a large hard fwelling without pain, of
one, or both the legs and thighs, which has been
called a dropfy, but is very different from the com-
mon difeafe of that name. It comes on, and goes
off fuddenly. It has lately been called in England
the dumb gout. In the fpring of 1 798 I attended
Col. Innesof Virginia in confultation with my Edin-

M 2 burgh

f Medical Reports on the Effefts of Hot and Cold
Water, p. 215.

1$6 OBSERVATIONS ON

uurgh friend and fellow fiudent, Dr. /ones of* the
fame ft ate. The Colonel had large anafarcous fwell-
ings in his thighs and legs, which wc had reafon to
believe were the effects of an indolent gout. Wc
made feveral pundlures in his feet and ankles, and
thereby difcharged a large quantity of water from
his legs and thighs. A day or two afterwards his
ankles exhibited in pain and inflammation, the ufual
form of gout in thofe parts. In the year 1 794 I
attended Mrs. Lloyd Jones, who had a fwelling of
the fame kind in her foot and leg. Her conftitu-
lion, habits, and the fober manners of her an-
ceflors, gave me no reafon to fufpect it to arife
from the ufoal remote caufes of gout. She was
feveriih, and her pulfe was tenfe. I drew ten
ounces of blood from her, and gave her a purge.
The fwelling fubfided, but it was fucceeded by an
acute rheumatic pain in the part, which was cured
in a few days. I mention thefefafts as an addition-
al proof of the famenefs of the gout and rheuma-
tifm, and to fliew that the veffels in a Ample dif-
eafe, as well as in malignant fevers, are often op-
preifed beyond that point in which they emit the
fenfation of pain.

Under this bead, I (hall include an account of
the mucous difcharge from the urethra which fome-
times takes place in an attack of the gout, and

which

THE GOUT. 15/

which has ignorantly been afcribed to a venereal
gonorrhea. There is a defcription of this fymp-
tom of the gout in the 3d volume of the Phyfical
and Literary Effays of Edinburgh by Dr. Clark.
It was firft taken notice of by Sauvages by the
name of " gonorrhea podagrica" in a work enti-
tled Pathologia Methodica. I have known three
inflances of it in this city. In the vifits which the
gout pays to the genitals, it fometimes excites great
pain in the tefticles. Dr. Whyt mentions three
cafes of this kind. One of them was attended with
a troublefome itching of the fcrotum. I have feen
one cafe in which the tefticles were affected with
great pain, and the penis with an obflinate priapifm.
They fucceeded a fudden traiiilatipn ef the gout
from the bowels.

From the occafional difpofition of the gout to
produce a mucous difcharge from the urethra in
men, it is eafy to conceive that it is the frequent
caufe of the fiuor albus in women, for in them,
the gout which is retrained from the fect^ by a
caufe formerly mentioned is driven to other parts,
and particularly to that part which from its offices,
is more difpofed to invite difeafe to it, than any
other. The fiuor albus fumetimes occurs in females,''
apparently of the moil rohuft habits. In fuch per*
fons, more efpecially if they have been defcended

firora

I50 OBSERVATIONS ON

from gouty anceftors, and have -led indolent and
luxurious lives, there can be no doubt but the dif-
eafe is derived from the gout, and mould be treated
with remedies which act, not only upon the affect-
ed part, but the whole fyftem. An itching fimilar
to that I formerly mentioned in the anus, fometimes
occurs in the vagina of women. Dr. Lettfom has
defcribed it. In all the cafes I have known of it, I be-
lieve it was derived from the ufual caufes of the gout.

VII. There are many records in the annals of
medicine of the gout affecting the ikin. The ery-
fipelas, gangrene and petechias are its acute, and
tetters, and running fores are its ufual chronic forms
when it appears in this part of the body. I attend-
ed a patient with the late Dr. Hutchinfon in whom
the whole calf of one leg was deftroyed by a mor-
tification which fucceeded the gout. Dr. Alexan-
der of Baltimore informed me that petechias were
among the lad fymptoms of this difeafe in the
Rev. Mr. Oliver who died in the town of Balti-
more about two years ago. In the difpofition of
the gout to attack external parts, it fometimes af-
fects the eyes and ears with the mofl: acute and
diftreffing inflammation and pain. I hefitate the lefs
in afciibirig them both to the gout, becaufe they not
only occur in gouty habits, but becaufe they now
and then effufe a calcarious matter of the fame na-
ture

THE GOUT. 159

ture with that which is found in the ligaments of
the joints.

VIII. Even the bones are not exempted from the
ravages of this difeafe. I have before mentioned
that the bones of the hands and feet are fometimes
diflocated by it. I have heard of an inftance in
which it diflocated the thigh bone. It probably
produced this effect by the effufion of chalk-ftones,
or by an excrefcence of flefh in the cavity of the
joint. Two inflances have occurred in this city of
its diflodging the teeth, after having produced the
mod diftreffmg pains in the jaws. — The long pro-
tracted, and acute pain in the face which has been
fo accurately defcribed by Dr. Fothergill, probably
arifes wholly from the gout acting upon the bones of
the part affected.

I have more than once hinted at the famenefs of
fome of the ftates of the gout, and the yellow fe-
ver. Who can compare the fymptoms and feats of
both difeafes, and not admit the unity of the re-
mote and proximate caufes of fever ?

Thus have I enumerated proofs of the gout being
a difeafe of the whole fyftem. I have only to add
under this proportion, that it affects different parts
of the body in different people according to the

nature

l6<3 OBSERVATIONS ON

nature- of their congenial, or acquired tempera-
ments, and that it often paries from one part of
the body to another in the twinkling of an eye.

The morbid excitement, and actions of the gout,
when feated in the ligaments, the blood-veiTels, and
vifcera, and left to themfelves, produce effects diffe-
rent in their nature, according to the parts in
which they take place. In the vifcera they pro-
duce congeftions compofed of all the component
parts of the blood. From the blood-veffels which
terminate ia hollow cavities and in cellular mem-
brane, they produce thofe effufions of ferum which
compofe dropfies. From the fame velTels, proceed
thofe effufions which produce on the lkin eryfipelas,
tetters, and all the different kinds of eruptions. In
the ligaments they produce an effufion of coagula-
ble lymph, which by ftagnation is changed into what
are ca.1'. d chaik-flones. In the urinary organs
they produce an effufion of particles of coagulable
lvmnh or red blood, which under certain circum-
fiances, are changed into fand, gravel and (tone.
All thefe obfervations are liable to fome exceptions.
There are inftances in which chalk-flones have been
found in the lungs, mouth, on the eye-lids, and
in the pailages of the ears, and a preternatural
fmx of water and blood has taken place from the
jvidneys. Pus has likewife been formed in the

joints.

THE GOUT. 1 6i

joints, and air has been found in the cavity cf the
belly raftead of water.

Sometimes the gout is faid to combine with the
fevers which ariie from cold and contagion. We
are not to fuppofe from this circumfhmce, that the
fyftem is under a peculiar ftimulus from the gout*
Ey no means. The fymptoms which are afcribed
to the gout, are the effects of morbid excitement
excited by the cold, or contagion acting upon parts
previoufly debilitated by the ufual remote caufes of
that difeafe.

From a review cf the fymptoms of the gout,
the impropriety of diftinguiihing it from its various
feats, by fpeciflc names, mufl be obvious to the rea-
der. As well might we talk of a yellow fever in the
brain, in the nerves, or in the groin, when its fymp-
toms affect thofe parts, as talk of mi/placed^ or retro-
cedent gout. The great toe and the joints of the
hands, and feet aretio more its exclufive feats, than
the " flomach is the^hrone of the yellow fever."
In fhort, the gout may be compared to a monarch
whofe empire is unlimited. The whole body
crouches before it.

It has been faid as a reflexion upon our profeffion,
that phyficians are always changing their opinions
refpecling chronic difeafes. For a long while they

were

1.&2 OBSERVATIONS ON

were all clafTed under the heads of nervous, or bili-
ous. Thefe names for many years afforded a fanc-
tuary for the protection of fraud and error in medi-
cine. They have happily yielded of late years to the
name of gout. If we mean by this difeafe a primary
affection of the joints, we have gained nothing by
affuming that name, but if we mean by it a difeafe
which confifts fimply of morbid excitement, invited
by debility, and difpofed to invade every part of the
body, we conform our ideas to fa&s, and thus fim-
plify theory and practice in chronic difeafes.

I proceed now to treat of the method of cure.

Let not the reader ftartle when I mention curing
the gout. It is not a facred difeafe. There will be no
profanity in handling it freely. It has been cured
often, and I hope to deliver fuch directions under
this head, as will reduce it as much under the power
of medicine, as a pleurify or an intermitting fever.
Let not fuperftition fay here, that the gout is the
juft puniihment of folly, and vice, and that thejuf-
tice of heaven would be defeated by curing it. The
venereal difeafe is more egregioufly the effect, of vice
than the gout, and yet heaven has kindly directed
human reafon to the difcovery of a remedy which
effectually eradicates it from the constitution. This
opinion of the govt betpg a curable difeafe, is as hu-
mane

THE GOUT. . 163

mane as it is juft. It is calculated to prompt to ear-
ly applications for medical aid, and to prevent that
defpair of relief which has contributed much to its
duration, and mortality.

But does not the gout prevent other difeafes, and
is it not improper upon this account to cure it ? I
anfwer, that it prevents other difeafes, as the daily
ufe of drams, prevents the intermitting fever. In
doing this, they bring on an hundred more incurable
morbid affections. The yellow fever carried offma-
ny chronic difeafes in the year 1793, and yet who
would wiih for, or admit fuch a remedy for a fimilar
purpofe ? The practice of encouraging, and invit-
ing what has been called a friendly fit of the gout
as a cure for other difeafes, refembles the practice of
fchool boys who fwallow the (tones of cherries to
am* ft their ftomachs in digefting that delicate fruit.
It is no more neceffary to produce the gout in the
feet, in order to cure it, than it is to wait for, or
encourage abfceffes or natural haemorrhages, to cure
a fever. The practice originated at a time when
morbific matter was fuppofed to be the caufe of the
gout, but it has unfortunately continued under the
influence of theories which have placed the feat of
the difeafe in the folids.

The

164 OBSERVATIONS ON

The remedies for the gout naturally divide them-
felves into the following heads.

I. Such as are proper in its approaching, or form-
ing ftate.

II. Such as are proper in violent morbid action in
the blood-veiTels, and vifcera.

III. Such as are proper in a feeble morbid action
in the fame parts of the body.

IV. Such as are proper to relieve certain local
fymptoms which are not accompanied by general
morbid action, and

V. Such as are proper to prevent its recurrence,
•r in other words to eradicate it from the fyflem.

I. The fymptoms of an approaching fit of the gout
are great languor, and dulriefs of body, and mind,
dozinefs, giddinefs, wakefulnefs, or ileep difturbed
by vivid dreams, a drynefs, and fometimes a cold-
*izis, numbnefs, and prickling in the feet and legs, oc-
cafional chills, acidity and flatulency in the ftomach,
with an increafed, a weak, or a defect of appetite.
Thefe fymptoms are not univerfal, but more or lefs
of them uflier in nearly every fit of the gout. The
reader will fee at once their famenefs with the pre-
monitory fymptoms of fever from cold and contagi-
on,

THE COUT. I65

pn, and affcnt from this proof, in addition to others
formerly mentioned, to the propriety of confidering
a fit of the gout, as a paroxyfm of fever.

The fyftem during the exiflence of thefe fymptoms
is in a (late of debility. The difeafe is as yet unform-
ed, and may eafily be prevented by the lofs of a few
ounces of blood, or if this remedy be objected to, by
a gentle dofe of phyfic, and afterwards by bathing
the feet in warm water, by a few drops of the fpirit
of hartfhorn in a little fage or camomile tea, by a
draught of wine-whey, or a common dofe of liquid
laudanum.

It is worthy of notice, that if thefe remedies are
omitted, all the premonitory fymptoms that have
been mentioned difappear as foon as the arthritic fe-
ver is formed, juft as latitude and chillinefs yield to
a paroxyfm of fever from other caufes.

II. Of the remedies that are proper in cafes of
<?reat morbid action in the blood-veiTels and vifcera.

I fhall begin this head by repudiating the notion
of a fpeciiic cure for the gout exifting in any fingle ar-
ticle of the materia medica. Every attempt to cure
it by elixirs, diet-drinks, pills, or boluiTes which
were intended to act fingly upon the fyftem, has been

1 66 OBSERVATIONS ON

as unfuccefsful as the attempts to cure the whooping
cough by fpells, or tricks of legerdemain.

The firfl remedy that I fhall mention for reducing
great morbid action in the blood-veffels and vifcera
is blood-letting. I was firfl taught the fafety
of this remedy in the gout by reading the works of
Dr. Lifter nearly thirty years ago, and I have ufed it
ever fince with great advantage. It has the fancYion
of Dr. Hoffman, Dr. Cullen.and many others of the
firfl names in medicine in its favour.

The ufual objections to bleeding as a remedy,
have been urged with more fuccefs in the gout, than
in any other difeafe. It has been forbidden, becaufe
the gout is faid to be, a difeafe of debility. This
is an error. Debility is not a difeafe. It is
only its predifpofmg caufe. Difeafe is preternatural
ftrength in the ftate of the fyflem now under confi-
deration, occafioned by the abflra&ion of excitement
from one part, and the accumulation of it in another
part of the body. Every argument in favor of bleed-
ing in a pleurify, applies in the prefent inflance, for
they both depend upon the fame kind of morbid acti-
on in the blood-veffels. Bleeding acts morever alike
in both cafes by abflracting the excefs of excitement,
from the blood-veffels, and refloring its natural and
healthy equality to every part of the fyflem.

THE GOUT. 1 67

It has been further faid, that bleeding difpofes to
more frequent returns of the gout. This objection
to the lancet has been urged by Dr. Sydenham who
was mifled in his opinion of it, by his theory of the
difcafe being the offspring of morbific matter. The
affertion is unfounded, for bleeding in a fit of the
gout has no fuch effect, provided the remedies to be
mentioned hereafter are ufed to prevent it. But a
fit of the gout is not fmgular in its difpofition to re-
cur after being once cured. The rheumatifm, the
pleurify, and the intermitting fever are all equally dif-
pofed to return when perfons are expofed to their re-
mote and exciting caufes, and yet we do not upon this
account confider them as incurable difeafes, nor do
we abflain from the ufual remedies which cure them.

The inflammatory or violent flate of the gout is
faid moft commonly to affect the limbs. But this is
far from being the cafe. It frequently makes its firffc
attack upon the head, lungs, kidneys, flomach, and
bowels. The remedies for expelling it from the flo-
mach and bowels are generally of a Simulating na-
ture. They are as improper in full habits, and in the
recent flate of the difeafe, as cordials are to drive
the fmall-pox from the vitals to the flan. Hundreds
have been deflroyed by them. Bleeding in thefe
cafes, affords the fame fpeedy, and certain relief
that it does in removing pain from the flomach and

bowels

l68 OBSERVATIONS ON

bowels in the firfl ftage of the yellow fever. CoL
Miles owes his life to the lofs of 60 ounces of blood
in an attack of the gout in his bowels in the winter
of 1 795, and Major Butler derived the fame benefit
from the lofs of near 30 ounces, in an attack of the
gout in his ftomach in the fpring of 1798.

I have faid, in the hiftory of the fymptoms of the
gout, that it fometimes appeared in the form of a
hectic fever. I have prefcribed occafional bleedings
in a cafe of this kind accompanied with a tenfe pulfe,
with the happiefl effects. It has confined the difeafe
for feveral years wholly to the blood-velfels, and it
bids fair in time to eradicate it from the fyftem.

The fbte of the pulfe as defcribed in another place,*
fhould govern the ufe of the lancet in this difeafe.
Bleeding is required as much in its deprefied, as in
its full and chorded (late. Col. Miles's pulfe at the
time he fufiered from the gout in his bowels, was
fcarcely perceptible. It did not rife till after a fe-
cond or third bleeding.

Some advantage may be derived from examining
the blood. I have once known it to be difiblved ;
but for the moil part I have obferved it, with Dr.

Lifter,

* Medical Inquiries and Obfervations, vol iv.

THE GOUT. l6()

, r, to be covered with did bully coal g£ com-
mon inflammation.

The arguments made ufe of in favour of bleed-
ing in the difeafes of old people in a former publi-
cation, apply with equal force to its ufe in the
gout. The inflammatory flate of this difeafe, fre-
quently occurs in the decline of life, and bleeding
is as much indicated in fuch cafes as in any other
inflammatory fever. The lare Dr. Chovet died
with an inflammation in his liver from gout, in the
86th year of his age. He was twice bled, and his
blood each time was covered with a buffy coat.

Where the gout affech the head with obftinatc
pain, and appears to be feated in the mufcles, cup-
ping gives great relief. This mode of bleeding
fhould be trufted in thofe cafes only in which the
morbid action is confined chiefly to the head, and
appears in a feeble flate in the refl of the arterial
fyflem.

The advantages of bleeding in the gout, when
performed under all the circumflances that have
been mentioned, are as follow :

1. It removes or lefTens pain,

N 2. It

I/C OBSERVATIONS ON

2. It prevents thofe congeftions and ertuuoris
which produce apoplexy, palfy, pneumonia notha,"
eajculi in the kidneys and bladder, and chalk-ftones
in the hands and feet. The gravel and (tone are
nine times ia ten, I believe, the effects of an effu-
iion o^ lymph cr blood from previous morbid ac-
tion in the kidneys. If this difeafc were nan-
watched, and cured as often as it occurs, by the
lofs of blood, we mould have but little gravel or
done among gouty people. A citizen of Philadel-
phia died a few years ago in the 96th year of his
age, who had been fubject to the flrangury the great-
eft part of his life. His only remedy for it was
bleeding. He lived free from the gravel and (lone
and died, cr rather appeared to fall afieep in death,
from old age. Dr. Haller mentions a fimilar cafe
in his Bibliotheca Medicime in which bleeding had
the fame happy effects.

3. It prevents the fytlem from wearing itfclf
down by frmtlefs pain and ilcknefs, and the:
inducing a predifpofnion to frequent returns of the
difeafe.

4. It iliortens the duration of a fit of gout by till-
ing it, not into the feet, but out of the fyftem,
and thus prevents a patient's lying upon his back
for two or three months with a writhing face,

fee; .

THE GOUT. I71

fcoluing a wife and a family of children, and fdme-
timcs curfing every fervant that comes near enough
to endanger the touch of an inflamed limb. Be fides
preventing all this parade of pain and peevifimefs,
it frequently, when affnled with other remedies to
be mentioned prefently, reflores a man to his bufi-
nefs and fociety in two or three days, a circum-
flancc this of great importance in the public, as well
as private purfuits of men ; for who has not read
of the' mod interefting affairs of nations being ne-
glected or protracted, by the principal agents in
them being fuddenly confined to their beds, or
chairs, for weeks or months, by a fit of the gout ?

2. A fecond remedy in the ftate of the gout which
has been mentioned, is purging. Sulphur is ge-
nerally preferred for this purpofe, but caftor oil,
cream of tartar, fena, jalap, rhubarb and calomel,
may all be ufed with equal fafety and advantage.
The flomach and habits of the patient fhould de-
termine the choice of a fuitable purge in every
cafe. Salts are generally offenfive to the ftomach.
They once brought on a fit of the gout in Dr.
Brown.

3. Vomits may be given in all thofe cafes where
bleeding is objected to, or where the pulfe is only
moderately active. Mr. Small, in an excellent pa-

N 2 per

172 OBSERVATIONS ON*

per upon the gout, in the 6th volume of the Me-
dical Obfervations and Inquiries, p. 205, contain-
ing the hiftory of his own cafe, tells us that he
always took a vomit upon the firfl attack of the
gout, and that it never failed of relieving all its
iymptoms. The matter difcharged by this vomit
indicated a morbid flate of the liver, for it was al-
ways a dark greenifh bile which was infoluble in
water. A Britifli lieutenant whofe misfortunes- re-
duced him to the neceffity of accepting a bed in
the poor-houfe of this city, informed the late Dr.
Stuben that he had once been much afflicted with
the gout, and that he had upon many occafions
flrangled a fit of it by the early ufe of an emetic.
Dr. Pye adds his teftimony to thofe which have
been given in favour of vomits, and fays further,
that they do moil fervice when they difcharge an
acid humour from the flomach. They appear to
act in part by equalizing the divided excitement of
the fyflem, and in part by difcharging the contents
of the gall-bladder and flomach, vitiated by the
previous debility of thofe organs. Care ihould be
taken not to exhibit this remedy where the gout
attacks the flomach with fymptoms of inflammation,
or where it has a tendency to fix itfelf upon the
brain.

4. Nitre

THE GOUT. I73

4. Nitre may be given with advantage in cafes
of inflammatory action where the ftomach is not

affected.

5. A fifth remedy is cool or cold air. This is
as fafe and nfeful in the gout as in any other in-
flammatory ftatc of fever. The affe&ed limbs
fhould be kept out of bed, uncovered. In this way
Mr. Small fays he moderated the pains of the gout
in his hands and feet. * I have directed the fame
practice with great comfort, as well as advantage
to my patients. Even cold water has been applied
with good effects to a limb inflamed by the gout.
Mr. Blair M'Clenachan taught me the fafety and
benefit of this remedy by ufing it upon himfelf
without the advice of a phyfician. It inftantly re-
moved his pain, nor was the gout tranfiated by it
to any other part of his body. Perhaps it would
be beft in moft cafes to prefer cool or cold air to
cold water. The fafety and advantages of both
thefe modes of applying cold to the affected limbs,
ihew the impropriety of the common practice of
wrapping them in flannel.

6. Diluting liquors, fuch as are prefcribed in
non inflammatory fevers, fhould be given in

fuch

.1 Obfervations and Inquiries, vol. vi, p. 201.

7_;. OBSERVATIONS ON

fuch quantities as to difpofe to a gentle perfpira-
tion.

7. Abflinence from wine, fpirits, and malt li-
quors, alfo from fuch aliments as afford much nou-
rifhment or ftimulus, fhould be carefully enjoined.
Sago, panada, tapioca, diluted milk with bread,
and the pulp of apples, fummer fruits, tea, coffee,
weak chocolate, and bread foaked in chicken water
or beef tea, fkould conflitute the principal diet of

lents in this ftate of the gout.

8. BHfters are an invaluable remedy in this dif-
eafc when ufed at a proper time, that is, after the
redaction of the morbid actions in the fyfiem by

ions evacuations. They mould be applied to
the legs and wrifts in general gout, and to the neck
and fees, when it attacks the head or bread. A
flrangury from the gout, is no cbjccucn to their
life. So far from incrcafng this complaint, Dr.
Clerk and Dr. Whyt inform us, that they remove
it. * But the principal advantage of bliflers is de-

I from their collecting and concentrating, flat-
tered and painful fenfatiens, and conveying them
out of the fyfiem, and thus becoming excellent fub-
fUtntes for a fit of the gout.

9. Fear

• Fhyflcal and Literary IL&ys, vcl. iii. p. 469.

THE GO I

/ D

9. Fear and terror have in fgme inftaoces cured
a paroxyfm of this difeafe. A captaiti of a Britifh
Clip of war who had been confined for feveral
weeks to his cabin, by a fevere fit of the gout in
his feet, was fuddenly cured by hearing the cry of
fire on board his ihip. This fact was communicat-
ed to me by a gentleman who was a witnefs of it.
Many fimilar cafes are upon record in books of me-
dicine. I {hall in another place jnfert an account of
one in which the cure effected by a fright, eradi-
cated the difeafe from the fyftem fo completely, as
ever afterwards to prevent its return.

Thus have I enumerated the remedies which are
proper in the gout when it affects the blood-veffcls
and vifcera with great morbid action. Moft of
thofe remedies are alike proper when the morbid
actions are feated in the mufcular fibres, whether
of the bowels or limbs, and whether they produce
local pain, or general convulilon ; provided they
are of a violent nature.

ere are feme remedies under this head of a
itful nature, on which I mail make a few ob-
:is.

Sweating has been recommended in this flate
of the gout. All the objections to it in preference

lyG OBSERVATIONS ON

to other modes of depletion, mentioned in another
place, # apply ag'ajnft its ufe in the inflammatory
ib.te of the gout. It is not only lefs fafe than
bleeding, purging, and abftinence, but it is often
an impracticable remedy. The only fudoriflc me-
dicine to be trailed in this ftate of the difeafe is
the Seneka fnake-root. It promotes all the fecre-
tions and excretions, and exerts but a feeble flimu-
lus upon the arterial fyftem.

Many different preparations of opium have been
advifed in this (fate of the gout. They are all
hurtful if given before the morbid action of the
fyftem is nearly reduced. It mould then be given
in fmall dofes accommodated to the excitability of
the fyftem.

Applications of various kinds to the affected
limbs have been ufed in a fit of the gout, and fome
of them with fuccefs. The late Dr. Chalmers of
South Carolina ufed to meet the pain of the gout
as foon as "it fixed in any of his limbs, with a blifter,
and generally removed it by that means in two or
three days. I have imitated this practice in feve-
ra! cafes, and always with fuccefs, nor have I ever
feen the gout thrown upon any of the vifcera by

means

* Judical Inquiries and Obfervations, vol. iv.

THE GOUT. 177

means of this remedy. Cauftics have fometimes
been applied to gouty limbs with advantage. The
moxa defcrihed, and ufed by Sir William Temple,
which is nothing but culinary fire, has often not
only given relief to a pained limb, but carried off
a fit of the gout in a few hours. Thefe powerful
applications may be ufed with equal advantage in
thofe cafes in which the gout by falling upon the
head produces coma, or fymptoms of apoplexy.
A large cauftic to the neck, roufed Mr. John M.
Nefbit from a coma in which he had lain for three
days, and-thereby appeared to fave his life. Blif-
ters, and catapi&fms of muftard, had been previ-
oufiy ufed to different parts of his body, but with-
o; t ihe lefcft effect. In cafes of moderate pain,
where a bliiler has been objected to, I have feen a
cabbage leaf afford confiderable relief. It produ-
ces a moifture upon the part affected, without ex-
citing any pain. An old fea captain taught me to
apply molaiTes to a limb inflamed or pained by the
gout. I have frequently advifed it, and generally
with advantage. All volatile and flimulatin^ lini-
ments are improper, for they not only endanger a
tranflation of the morbid excitement to the vifcera,
but where they have not this effect, they increafe
the pain, and inflammation of the part affected.

The

lyS OBSERVATIONS ON

The fooner a patient exercifcs his lower limbs by-
walking, after a fit of the gout, the better. " I
made it a confcant rule (fays Mr. Small) to walk
abroad as foou as the inflammatory ftate of the
gout was pall, and though by fo doing, I often
fullered great pain, I am well convinced that the
free ufe I now enjoy of my limbs, is chiefly owing
to my determined perfeverance in the ufe of that
exercife ; nor am I lefs pcriiiaded that nine in ten
of gouty cripples owe their lamenefs more to in-
dolence and fear of pain, than to the genuine
effects of the gout." * Sir William Temple con-
firms the propriety of Mr. Small's opinion and
practice, by an account of an old man who obvi-
ated a fit of the gout as often as he felt it coming
in his fccty by walking in the open air, and after-
wards by going into a warm bed, and having the
parts well rubbed where the pain began. " By
following this courfe (he fays) he was never laid
up with the gout, and before his death recommend-
ed the fame courfe to his fon if ever he fliould
fill into that accident." Under a conviction of the
fafety of this practice the fame author concludes the
hiflory of his own cafe in the following words.
" I favoured it [viz. the fwelling in my feet] all
this while more than I needed, upon the common

opinion,

* Medical Obfervations and Jnqu:ries; vol. vi. p. 220.

THE GOUT. iyg

opinion, thut wall too much might draw dawn
the humour, which I have iince had reafon to con-
clude a great miflakc, and that if I had walked as
much as I could from the firfl day the pain left me,
the fweliing might have left me too in a much lefs

III. I come now to mention the remedies which

proper in that flate of the gout in which a feeble

morbid action takes place in the biocd-veflels and

I mail begin this head, by remarking, that this
flate of the gout is for the molt part created, like
the typhus ftate of fever, by the neglect, or too
fcantv ufe of evacuations in its firfl; (la^e. When
the prejudices which now prevent the adoption of
thofe remedies in their proper time, are removed,
we (hall hear but little of the low itate of the ar-
thritic fever, nor of the numerous diforders from
obflruction which are produced by the blood-vefTels
diforganizing the vifcera, by repeated and violent
attacks of the difeafe.

To determine the character of a paroxyfin of
gout and the remedies proper to relieve it, the cli-
mate,

* Eday upon the Cure cf the Gout by Mo.xa, vol. i. folio
n, p. 143 and 141.

l8o OBSERVATIONS ON

mate, the feafon of the year, the conftitution of
the atmofphere, and the nature of the prevailing
epidemic, fhould be carefully attended to by a phy-
fician. But his principal dependance fhould be
placed upon the ftate of the pulfe. If it does not
difcover the marks which indicate bleeding formerly
referred to, but is weak, quick and foft, the reme-
dies fhould be fuch(as are calculated to produce a
rnore vigorous, and equable action in the blood-vef-
fels and vifcera. They are,

i. Opium. It fhould at firfh be given in final!
dofes, and afterwards increafed, as circumftances
may require.

2. Madeira or Sherry wine alone, or diluted with
water, or in the form of whey, or rendered more
cordial by Laving any agreeable fpice infufed in it.
It may be given cold, or warm, according to the
tafte of the patient, or the ftate of his ftomach.
If this medicine be rejected in all the above forms,

3. Porter fhould be given. It is often retained,
when no other liquor will lay upon the ftomach. I
think I once faved the life of Mr. Nefbit by this
medicine. It checked a vomiting, from the gout,
which feemed to he the lafl iymptom of his depart-
ing life. If porter fails of giving relief,

4. Ardent

THE GOUT. l2l

4. Ardent fpirits fhould be given, either alone,
or in the form of grog, or toddy. Cafes have oc-
curred in which a pint of brandy has been taken in
the courfe of an hour" with advantage. Great be-
nefit has fometimes been found from Dr. Warner's
tincture, in this (late of the gout. As thefe obfer-
vations may fall into the hands of perfons who may
not have accefs to Dr. Warner's book, I mall here
infert the receipt for preparing it.

Of raifons fliccd and (loned, half a pound.
Rhubarb, one ounce.
Sena, two drachms.

Coriander and fennel feeds, of each one drachm.
Cochineal, faffron and liquorice root, each half
a drachm.

Infufe them for ten days in a quart of French
brandy, then (train it and add a pint more of bran-
dy to the ingredients, afterwards (train it, and mix
both tinctures together. Four table fpoons full of
this cordial are to be taken every hour mixed with
an equal quantity of water, until relief be obtained.

Ten drops of laudanum may be added to each
dofe in thofe cafes in which the cordial does not
produce its intended effects, in two or three hours.
— If all the- different forms of ardent fpirits which
have been mentioned fail of giving relief,

From

lS2 OBSERVATIONS* ON

5. From 30 drops to a tea fpoonful of at her mould
be given in any agreeable vehicle. Alfo,

6~. Volatile alkali. From five to ten grains of
this medicine fliould be given every two hours.

7. Aromatic fubftances, fuch as alfpice, ginger,
Virginia fnakc-root, cloves, and mace in the form
of teas, have all been ufeful in this ftate of the
gout.

All thefe remedies are indicated in a more efpecial
manner when the gout affects the ftomach. They
are like wife proper when it affects the bowels. The
laudanum in this cafe mould be given by way of gly-
ftcr. After the vomiting was checked in Mr. Nefbit
by means of porter, he was afflicted with a dull and
diftrefling pain in his bowels, which was finally re-
moved by two anodyne glyflers injected daily for two
or three weeks.

8. Where the gout produces fpafmodic or con-
vulfive motions, the oil of amber may be given
with advantage. I once few it remove for a while
a convulfive cough from the gout.

9. In cafes where the flomach will bear the bark,
it (hould be given in large and frequent dofes. It

does

THE GOUT. I S3

does the fame fervice in this ftate cf gout, that it does
in the flow or low dates of fever from any other caufe.
Where the gout appears in the form of an intermit-
tent, the bark affords the fame relief that it does in
the fame difeafe from autumnal exhalations. Mr.
Small found great benefit from it after difchargmg
the contents of his flomach and bowels by a dofe of
tartar emetic. " I do not call (fays this gentleman)
a fit of the gout a paroxyfm', for there are feveral
paroxyfms in the fit, each of which is ufhered in
with a rigor, ficknefe at flomach, and fubfequent
heat. In this the gout bears a. refembiance to an
irregular intermittent, at leafl to a remitting fever,
and hence perhaps the efficacy of the bark in
removing the gout."*

10. The warm bath is a powerful remedy in excit-
ing a regular and healthy a&ion in the fanguiferous
fyftem. Where the patient is too weak to be taken
out of bed, and put into a bathing tub, his limbs
and body mould be wrapped in flannels dipped in
warm water. In cafe of a failure of all the above
remedies,

11. A salivation fhouid be excited as fpeedhy
as poffible by means of mercury. Dr. Cheyne com-
mends it in high terms. I have once ufed it wii1;

iuccefi
* Medical Observations and Inquiries vol. vi. p. 220,

I §4 OBSERVATIONS Otf

fuccefs. The mercury when ufed in this way, brings
into action an immenfe mafs of latent excitement,
and afterwards diffufes it equally through every
part of the body.

12. Befides thefe internal remedies, frictions with
brandy, and volatile liniment fhould be ufed to the
ftomach and bowels. Bliflers fhould be applied to
parts in which congeftion, or pain is feated, and
Itimulating cataplafms mould be applied to the low-
er limbs. The flour of muftard has been juflly pre-
ferred for this purpofe. It fhould be applied to thc-
upper part of the foot.

The reader will perceive in the account I have
given of the remedies proper in the feeble flate of
chronic fever, that they are the fame which are
ufed in the common typhus, or what is called nerv-
ous fever. There is no reafon why they fhould not
be the fame, for the fuppofed two morbid ftates of
the fyftem, are but one difeafe.

It is agreeable in medical r^fearches to be under
the direction of principles. They render unnecefTary
in many inflances, the flow and expenfive operati-
ons of experience, and thus multiply knowledge, by
leffening labor. The fcience of navigation has reli-
ed upon this bafis, fince the difcovery of the load-

ftone,

THE GOUT 185

fame. A mariner who has navigated a fhip to one
diftant port, is capable of conducting her to every
port upon the globe. In like manner, the phyfician
■who can cure one difeafe by a knowledge of its prin-
ciples, may by the fame means cure all the difeafes
of the human body, for their caufes are the fame.
Judgment is required, only in accommodating the
force of remedies, to the force of each difeafe.
The difference in difeafes which arifes from their
feats, from age, fex, habit, feafon and climate,
may be known in a fhort time, and is within the
compafs of very moderate talents.

IV. Were I to enumerate all the local fymptoms
of gout which occur without fever, and the remedies
that are proper to relieve them, I fhould be led
into a tedious digreflion. The reader muft confult
practical books for an account of them. I fhall only
mention the remedies for a few of them.

The theory of the gout which has been delivered,
will enable us to underftand the reafon why a dif-
eafe which properly belongs to the whole fyftem,
mould at any time be accompanied only with local
morbid affection. The whole body is an unit, and
hence morbid impreiTions which are refifted by found
parts, are propagated to fuch as are weak, where
they excite thofe morbid actions we call difeafe.

O The

3(5

OBSERVATIONS ON

The.HEAD-ACH is a diftrefling fymptom of the
gout. It yields to depleting or tonic remedies ac-
cording to the degree of morbid action which ac-
companies it. I have heard an inflance of an old man
who was cured of an obftinate head-ach by throw-
ing afide his night cap, and fleeping with his bare-
head expofed to the night air. The difeafe in this
cafe was probably attended with great morbid action.
In this flatc of the vefTels of the brain, cupping, cold
applications to the head, purges, a temperate diet,
and blifcers behind the ears, are all proper remedies,
and fliould be ufed together, or in fucceflion, as the
nature of the difeafe may require. Many perfons
have been cured of the fame complaint by fleeping
in woollen night caps. The morbid action in thefe
cafes is always of a feeble nature. With this reme-
dy, tonics, particularly the bark and cold bath, will
be proper. I have once known a chronic gouty
pain in the head, cured by an iifue in the arm, after
pounds of bark, and many other tonic remedies had
been taken to no purpofe.

The ophthalmia from gout fliould be treated with
the ufual remedies for that difeafe when it arifes
from other caufes, with the addition of fuch local
applications to other and diftant parts of the body,
as may abftracl: the gouty action from the eyes.

Dull

The gout. 187

Dull but conftant pains in the limbs yield to fric-
tions, volatile liniments, muflin and woollen worn
next to the fkin, electricity, a falivatioa, and the
warm and cold bath. A gentleman who was afflict-
ed with a pain of this kind for three years and an
half in one of his arms, informed me that he had
been cured by wearing a Woollen (locking that had
been boiled with fulphur in water, for two weeks
upon the affected limb. He had previoufly worn
flannel upon it, but without receiving any benefit
from it. I have known wool and cotton finely
carded and made into fmall mats, worn upon the
hips when affected by gout, with great advantage.
In obftinate fciatic pains without fever or inflam-
mation, Dr. Pitcairn's remedy publifhed by Dr.
Cheyne has performed many cures. It confifts in
taking from one to four tea-fpoonfuls of the fine
fpirit of turpentine every morning for a week or
ten days in three times the quantity of honey, and
afterwards in drinking a Jarge quantity of fack
whey to fettle it on the flomach, and carry it into
the blood. An anodyne fhould be taken every
night after taking this medicine.

A gouty diarrhoea fhould be treated with the
ufual aftringent medicines of the (hops. Bliflers
to the wriils and ankles, alio a falivation, have
often cured it. I have heard of its being checked,

O 2 after

l88 OBSERVATIONS ON

after continuing for many years, by the patient
eating large quantities of alfpice, which he carried
loofe in his pocket for this purpofe.

The angina pectoris which I have faid is a fymp-
tom of the gout, generally comes on with fuinefs
and tenfion in the pulfe. After thefe are reduced
by two or three bleedings, mineral tonics feldom
fail of giving relief.

Spafms in the ftomach, and pains in the bowels
often feize gouty people in the midft of bufmefs or
pleafure, or in the middle of the night. My con-
front prefcription for thefe complaints is ten drops
of laudanum every half hour till relief be obtained.
If this medicine be taken in the forming flate of
thefe pains, a fingle dofe generally removes the dif-
eafe. It is preferable to fpiced wine and fpirits,
inafmuch as it acts quicker, and leaves no difpofi-
tion to contract a love for it when it is not requir-
ed to eafe pain.

The pain in the rectum which has been defcrib-
ed, yields to the common remedies for the piles.
Cold water applied to the part, generally gives im-
mediate relief.

The

THE GOUT. 189

The itching in the anus which I have fuppofecl
to be a fymptom of gout, has yielded in one in-
ftance that has come within my knowledge to mer-
curial ointment applied to the part affected. Dr.
Lettfom recommends fomenting the part with a
decoction of poppy heads and hemlock, and advifes
lenient purges and a vegetable diet as a radical
cure for the difeafe. *

For the itching in the vagina, I have found a
folution of the fugar of lead in water to be an ex-
cellent palliative application. Dr. Lettfom recom-
mends as a cure for it, the ufe of bark in delicate
habits, and occafional bleeding, with a light and
moderate diet, if it occur about the time of the
ceffation of the menfes.

Obflinate cutaneous eruptions which are the
effects of gout, have been cured by gentle phyfic,
a fuitable diet, iffaes, and applications of the un-
guentum citrinum to the parts affected.

The arthritic gonorrhea fhould be treated with
the fame remedies as a gonorrhoea from any other
caufe.

In the treatment of all the local fymptoms that

have been enumerated, it will be of great confe-

•, quence

* Medical Memoirs, vol. iii.

190 ElBSfRVATIOlH : y

quencc I fare we attempt to cure them,

I ucceedcd general gout, and

J the fyftem from its effects in part*

enential to life. If this has been the cafe, the

:, fhouid be undertaken with caution,

and the danger of a local difeafe being exchanged

neral one, ihould be obviated
that are calcula: uty dial:

altogether ft fyftem. The means for

purpofe, agreeably to our order, come next under
our conlideraticn. Before I enter upon this head,
I fhail premife, that I do not admit of the feeds
of the gout remaining in the body to be ited

by art after a complete termination of one c
par*: more than I admit of the feeds of

a pleur .rermitting fever remaining in the

body, after they have been cured by blood-letting
or bark. fpoStion only remains in the

fyftem to a return of the gout, frc fual re-

mote and exciting caui"^ lea took

life in th :: med . which morbific

mat: i to be the proximate cau:

the gout, but it has unfortunately continued fince
: theory. Thus in many cafes,
wrong habits continue long after the prin-
ciples have been cMfcarded, from which they

THE GOUT. I9I

I have known feveral inftances in which art, and
I have heard and read of others in which acciden-
tal fuffering from abftinence, pain and terror, have
been the happy means of overcoming a predifpofi-
tion to the gout. A gentleman from one of the
Weft India iflands who had been for many years
afflicted with the gout, was perfectly cured of it
by living a year or two upon the temperate di^t of
the jail in this city into which he was thrown for
debt by one of his creditors. A large haemor-
rhage from the foot inflamed and f welled by the
gout, accidentally produced by a penknife which
fell upon it, effected in an Irifh gentleman a lading
cure of the difeafe. Hildanus mentions the hiilory
of a gentleman whom he knew intimately, who
was radically cured of a gout with which he had
been long afflicted, by the extreme bodily pain he
fufTered innocently from torture in the Canton of
Berne. He lived to be an old man, and ever after-
wards enjoyed good health. * The following let-
ter from my brother contains the hiilory of a cafe
in which terror fuddenly eradicated the gout from
the fyftem.

ic Reading,

* Obfervat. Chirurg. Cent. I. Obf 79.

19- OBSERVATIONS ON

" Reading, July vjtb, 1797.
" Dear Brother,

<c WHEN I had the pleafure of feeing you
laft week, I mentioned an extraordinary cure of
the gout in this town, by means of a fright. In
compliance with your requeft, I now fend an exact
narration of the facts.

" Peter Fether the perfon cured, is now alive,
a houfeholder in Reading, feventy-three years of
age, a native of Germany, and a very hearty
man. The firft fit of the gout he ever had, was
about the year 1773 ; and from that time till 1785,
he had a regular attack in the fpring of every
year. His feet, hands, and elbows, were much
iwollen and ennamed— the fits laded long and were
excruciating. In particular the laft fit in 1785 was
fo fevere, as to induce an apprehenfion, that it
would inevitably carry him off — when he was fud-
denly relieved by the following accident.

" As he lay in a fmall back room adjoining the
yard, it happened that one of his fons in turning
a waggon and horfes, drove the tongue of the
waggon with fuch force againft the window near
which the old man lay ftretched on a bed, as to
heat in the falii of the window, and to fcatter the

pieces

THE GOUT. I93

pieces of broken glafs all about him. To fuch a
degree was he alarmed by the noife and violence,
that he inftantly leaped out of bed, forgot that he
had ever ufed crutches, and eagerly inquired what
was th« matter. His wife hearing the uproar, ran
into the room, where to her aftoniihment, flie
found her hufband on his feet, bawling againfi: the
author of the mifchief, with the mod paffionate

vehemence. From this moment, he has been

entirely exempt from the gout, has never had the
flighted touch of it — and now enjoys perfect health,
has a good appetite, and fays he was never hear-
tier in his life. This is probably the more remark-
able, when I add, that he has always been ufed to
the hard work of a farm ; andjince the year 1785
has frequently mowed in his own meadow, which I
underftand is low and wet. I am well informed,
in his mode of living, he has been temperate, oc-
cafionally indulging in a glafs of wine, after the
manner of the German farmers, but not to excefs.

" To you, who have been long accuftomed to
explore difeafes, I leave the tafk of developing the
principles, on which this myfterious reftoration
from the loWeft decrepitude and bodily wretched-
nefs, to a ftatc of perfect health, has been accom-
piifhed. I well know that tooth-aches, head-aches,
hiccoughs, &c. are often removed by the fudden

impreffion

194 OBSERVATIONS ON

impreffion of fear, and that they return again.
But to fee a debilitated gouty frame inftantly re-
flored to vigour — to fee the whole fyftem in a mo-
ment, (as it were) undergo a perfect and entire
change, and the moft inveterate and incurable dif-
order, radically expelled ; is furely a different thing,
and mufl be acknowledged a very fingular and mar-
vellous event. If an old man languifhing under
difeafe and infirmity, had died of mere fright, no
body would have been furprifed at it — But that he
mould be abfolutely cured, and his conflitution re-
novated by it, is a mod extraordinary fact ; which,
while I am compelled to believe by unexceptionable
evidence, I am totally at a lofs to account for.
I am your fmcerely

affectionate brother,
JACOB RUSH."

Thefe facts, and many fimilar ones which might
be mentioned, afford ample encouragement to pro-
ceed in enumerating the means which are proper
to prevent the recurrence of the gout, or in other
words to eradicate it from the fyftem.

V. I (hall firft mention the means of preventing
the return of that flate of the difeafe which is ac-
companied with violent action, and afterwards take
notice of the means of preventing the return of

that

THE GOUT. I95

that Hate of it, in which a feeble morbid action
takes place in the blood-veffcls. The means for
this purpofe confift in avoiding all the remote, ex-
citing, and predifpofmg caufes of the gout which
have been mentioned. I fhall fay a few words up-
on the mod important of them, .in the order that
lias been propofed.

I. The firft remedy for obviating the violent ftate
of gout is,

1. Temperance. This fliould be regulated in its
degrees by the age, habits and conftitution of the
patient. A diet confining wholly of milk, vege-
tables, and fimple water, has been found neceflary
to prevent the recurrence of the gout in fome cafes.
But in general, fifli, eggs, the white meats and
weak broths may be taken in fmall quantities once a
day, with milk and vegetables at other times.
A little falted meat which affords lefs nourifhment
than frefh, may be eaten occafionally. It imparts
vigour to the ftomach, and prevents dyfpepfia from
a diet confiding chiefly of vegetables. The low,
and acid wines fliould be avoided, but weak Madei-
ra or Sherry wine and water, or fmall beer may be
drunken at meals. The latter liquor, was the fa-
vourite drink of Dr. Sydenham in his fits of the
gout. Strong tea, and coffee fliould not be

tafted,

I96 OBSERVATIONS ON

tafted, where there is reafon to believe the habi-
tual ufe of them has contributed to bring on the
difeafe.

From the difpofition of the gouc to return in
the fpring, and autumn, greater degrees of abfti-
nence in eating and drinking will be neceffary at
thofe fcafons than at any other time. — In perfons
above fifty years of age, this abftemious mode of
living, mould be commenced with great caution.
It has fometimes when entered upon fuddcnly, and
carried to its utmofl extent, induced fits of the
gout, and precipitated death. In fuch perfons the
abftractions from their ufual diet fhould be final],
and our dependance fhould be placed upon other
means to prevent a return of the difeafe.

2. Moderate labour and gentle exercife, have
frequently removed that debility and vibratility in
the blood-veffels, on which a predifpofition to the
gout depends. Hundreds of perfons who have
been reduced by misfortunes, to the necefiity of
working for their daily bread, have thrown off a
gouty diathefis derived from their parents, or ac-
quired by perfonal acts of folly and intemperance.
The employments of agriculture afford the mod
wholefome labour ; and walking, the moil faluta-
ry exercife. To be ufeful, they fhould be mode-
rate.

THE GOUT. 197

rate. The extremes of indolence, and bodily acti-
vity, meet in a point. They both induce debility,
which predifpofes to a recurrence of a fit of the
gout. Riding in a carriage, and on horfe-back are
lefs proper as a means of preventing the difeafe,
than walking. Their action upon the body is partial.
The lower limbs derive no benefit from it, and on
thefe, the violent frate of gout generally makes its
firfl attack. In England many domeftic exercifes
have been contrived for gouty people, luch as
fliuttle-cock, bullets, the chamber-horfe and the
like, but they are all trifling in their effects, com-
pared with labour and exercife in the open air.
The efficacy of the former of thofe prophylactic
remedies will appear in a ftrong point of light
when we confider, how much the operation of the
remote and exciting caufes of the gout which act
more or lefs upon perfoas in the humbled ranks of
fociety, are conftantly counteracted in their effects,
by the daily labour which is neceffary for their fub-
fiftence.

3. To prevent the recurrence of the gout, cold
fhould be carefully avoided, more efpecialiy when
it is combined with moifture. Flannel fliould be
worn next to the fkin in winter, and muffin in fum-
mer, in order to keep up a fleady and uniform per-
foration. Fleecy hofiery fliould be worn in cold

weather

I98 OBSERVATIONS ON

weather upon the bread and knees, and the feet
fliould be kept conftantly warm and dry by means
of focks, and cork-foaled (hoes. It was by wetting
his feet, by {landing two or three hours upon the
damp ground, that Col. Miles produced the gout
in his ftomach and bowels which had nearly de-
ftroyed him in the year 1795.

4. Great moderation fhould be ufed by perfons
who are fubject to the gout in the exercife of their
understandings and paflions. Intenfe fludy, fear,
terror, anger, and even joy, have often excited the
difeafe into action. It has been obferved, that the
political and military paflions act with more force
upon the fyftem, than thofe which are of a focial
and domeflic nature ; hence generals and ftatefmen
are fo often afflicted with the gout, and that too
as was hinted in another place, in moments the
mofl critical and important to the welfare of a na-
tion. The combination of the exercifes of the un-
derstanding, and the paffion of avarice in gaming,
have often produced an attack of this difeafe.

Thefe facts fhew the neceflity of gouty people
fubjecting their minds, with all their operations, to
the government of reafon and religion. The un-
derstanding mould be exercifed only upon light and
pleafant fubject s. No ftudy fliould ever be pur-

fued

THE GOUT. I99

fued till it brings on fatigue ; and above all things,
midnight and even late ftudies fhould be ftri&ly
avoided. A gouty man lliould always be in bed at
an early hour. This advice has the fan&ion of Dr.
Sydenham's name, and experience proves its effica-
cy in all chronic difeafes.

5. The venereal appetite fhould be indulged with
moderation, and

6. Coftivenefs mould be prevented by all per-
fons who wifh to efcape a return of violent fits of
the gout. Sulphur is an excellent remedy for this
purpofe. Dr. Cheyne commends it in high terms.
His words are, " Sulphur is one of the belt re-
medies in the intervals of the gout. In the whole
extent of the materia medica, I know not a more
fafe and active medicine." * Two cafes have come
within my knowledge, in which it has kept off fits
of the gout for feveral years, in perfons who had
been accuitomed to have them once or twice a year.
Rhubarb in fmall quantities chewed, or in the form
of pills, may be taken to obviate coftivenefs, by
perfons who object to the habitual ufe of fulphur.
Dr. Cheyne who is lavifh in his praifes of that me-
dicine as a gentle laxative, fays, he " knew a noble

lord

* Eflay on the Nature, awd True Method of Treating
the Gout, p. 36.

23C OBSERVATIONS ON

lord of great worth and much gout, who, by tak-
ing from the hands of a quack, a drachm of rhu-
barb tinged with cochineal to difguife it, every
morning for fix weeks, lived in health for four
years after, without any fymptom of it." *

I have faid that abflinence fhould be enjoined
with more ftrichiefs in the fpring and autumn, than
at any other time, to prevent a return of the gout.
From the influence of the weather at thofe feafons
in exciting febrile actions in the fyflem, the lofs of
a pint of blood will be ufeful in fome cafes for the
fame purpofe. It will be the more neceffary if the
gout has not paid its habitual vifits to the fyflem.
The late Dr. Gregory had been accuftomed to an
attack of the gout every fpring. Two feafons
pafled away without his feeling any fymptoms
of it. He began to flatter himfelf with a hope
that the prcdifpofition to the dileafe had left
him. Soon afterwards he died fuddenly of an
apoplexy. The lofs of a few ounces of blood at
the ufual time in which the gout affe<fted him,
would probably have protracted his life for many
years. In the year 1796, in vifiting a patient, I
was accidentally introduced into a room where a
gentleman from the Delaware date had been lying

on
* P. 3c

THE GOUT. 201

on his back for near fix weeks with an acute fit of
the gout. He gave me a hiftory of his fufferings.
His pulfe was full and tenfe, and his whole body
was covered with fweat from the intenfity of his
pain. He had not had his bowels opened for ten
days. I advifed purging and bleeding in his cafe.
The very names of thofe remedies (lartled him, for
he had adopted the opinion of the falutary nature
of a fit of the gout, and therefore hugged his
chains. After explaining the reafon of my pre-
fcriptions, he informed me in fupport of them,
that he had efcaped the gout but two years in
twenty, and that in one of thefe two years he had
been bled for a fall from his horfe, and in the other,
his body had been reduced by a nervous fever,
prcvioufly to the time of the annual vifit of his
gout.

An epitome of all that has been faid upon the
means of preventing a return of the gout, maybe
delivered in a few words. A man who has had
one fit of it, mould confider himfelf in the fame
ftate as a man who has received the contagion of a
malignant fever into his blood. He fhould treat
his body as if it were made of glafs. By this
means he will probably prevent during his life, the
re-excitement of the difeafe.

Are

202 OBSERVATIONS ON

Are Issues proper to prevent the return of the
violent flate of gout ? I have heard of an inflance
of an iffue in the leg having been effectual for this
purpofe; but if the remedies before mentioned be
ufed in the manner that has been directed, fo un-
pleafant a remedy can feldom be neceffary.

Are Bitters proper to prevent a return of this
(late of gout ? It will be a fufficient anfwer to
this queftion to mention, that the Duke of Port-
land's powder, which is compofed of bitter ingre-
dients, excited a fatal gout in many people who
ufed it for that purpofe. I mould as foon expect
to fee gold produced by the operations of fire upon
copper or lead, as expect to fee the gout prevented
or cured by any medicine that acted upon the
fyftem without the aid of more or lefs of the re-
medies that have been mentioned.

II. We come now, in the laft place, to mention
the remedies which are proper to prevent a return
of that flate of gout which is attended with a feeble
morbid action in the blood-veffels and vifcera.

This flate of gout generally occurs in the evening
of life, and in perfons of delicate habits or in fuch
as have had their conflitutions worn down by re-
peated attacks of the difeafe.

The

THE GOUT. 203

The remedies to prevent it are,

1. A gently flimulating diet confiding of animal
food well cooked, with found old Madeira or Sherry
wine, or weak fpirit and water. Salted, and even
fmoaked meat may be taken in this ftate of the
fyflem with advantage. It is an agreeable tonic,
and is lefs difpofed to create plethora than frefli
meat. Pickles and vinegar fhould feldom be faded.
They difpofe to gouty fpafms in the ftomach and
bowels. Long intervals between meals fhould be
carefully avoided. The ftomach when overftretch-
ed or empty, is always alike predifpofed to difeafe.
There are cafes in which the evils of inanition in
the flomach will be prevented, by a gouty patient
eating in the middle of the night.

2. The ufe of chalybeate medicines. Thefe arc

more fafe when ufed habitually, than bitters. I

have long been in the practice of giving the different

preparations of iron in large dofes in chronic difeafes,

and in that ftate of debility which difpofes to them.

A lady of a weak conftitution informed Dr. Cheync

" that fhe once aiked Dr. Sydenham how long fhe

might fafely take fteel. His anfwer was, that fhe

might take it for thirty years, and then begin again

if fhe continued ill.***

Water

* Efiuy on the nature, and true method ef treating the
mat, P- 69-

204 OBSERVATIONS ON

Water impregnated with iron, either by nature,
or art, may be taken inftead of the folid forms of
the metal. It will be more ufeful if it be drunken in
a place where patients will have the benefit of coun-
try air.

3. The habitual ufe of the volatile tincture of
gum guaiacum, and of other cordial, and gently
fKmulating medicines. A clove of garlic taken once
or twice a day, has been found ufeful in debilitated
habits predifpofed to the gout. It poffeffes a won-
derful power in bringing latent excitement into ac-
tion.- It moreover a£ts agreeably upon the nerv-
ous fyftem.

Mr. Small found great benefit from breakfailing
upon a tea made of half a drachm of ginger cut
into fmall ilices, in preventing occafional attacks of
the gout in his flomach. The root of the faifafras
of our country might probably be ufed with advan-
tage for the fame purpofe. — Aurelian fpeaks of
certain remedies for the gout which he calls
" annalia."* The above medicines belong to this
clafs. To be effectual, they fliould be perfifted in,
not for one year only, but for many years.

4. Warmth

* Morborum ChrOnicorum. Lib. v. Cap. 2.

THE GOUT, 205

4. Warmth uniformly applied, by means of
faitable dreffes, and fitting rooms, to every part of
the body.

5. The warm bath in winter, and the temperate,
or cold bath in fummer.

6. Exercife. This may be in a carriage, or on
horfeback. The vifcera being debilitated in this
(late of predifpofition to the gout, are ftrengthened
in a peculiar manner by the gentle motion of a
horfe. Where this or other modes of paiHve exer-
cife cannot be had, frictions to the limbs and body
fliould be ufed every day.

7. Colli vcnefs fhould be avoided by taking occasi-
onally one or two table fpoons full of Dr. Warner's
purging tincture prepared by infufmg rhubarb,
orange peel, and caraway feeds of each an ounce
for three days in a quart of Madeira, or any other
white wine. If this medicine be ineffectual for
opening the bowels, rhubarb may be taken in the
manner formerly mentioned.

8. The underftanding and paflions mould be
conftantly employed in agreeable ftudies and pur-
fuits. Fatigue of mind and body, fliould be care-
fully avoided.

9- A

206 OBSERVATIONS ON

9. A warm climate often protra&s life in perfons
fubjecl: to this flate of gout. The citizens of
Rome who had worn down their conftitutions by
intemperance, added many years to their lives, by
migrating to Naples, and enjoying there in a warmer
fun, the pure air of the Mediterranean, and Sir
William Temple fays the Portuguefe obtain the
fame benefit from tranfporting themfelves to the
Brafils, after medicine and diet ceafe to impart
vigor to their conftitutions in their native country.

Thus have I enumerated the principal remedies
for curing and preventing the gout. Moft of them
are to be met with in books of medicine, but they
have been adminiftered by phyficians, or taken by
patients with fo little regard to the different dates
of the fyftem, that they have in many inftances
done more harm than good. Solomon places all
wifdom in the management of human affairs, in
finding out the proper times for performing certain
actions. Skill in medicine confifts in an eminent
degree in timing remedies. There is a time to
bleed, and a time to withhold the lancet. There
is a time to give phyfic, and a time to truft to the
operations of nature. There is a time to eat meat,
and there is a time to abflain from it. There is a
time to give tonic medicines, and a time to refrain
from them. In a word, the cure of the gout de-
pends

THE GOUT,

207

pcnds wholly upon two things, viz. proper reme-
dies, in their proper times, and places.

I fhall take leave of this difeafe, by comparing
it to a deep and dreary cave in a new country, in
which ferocious beafls, and venomous reptiles with
numerous ghofts and hobgobblins, are faid to refide.
The neighbours point at the entrance of this cave
with horror, and tell of the many ravages that
have been committed upon their domeflic animals,
by the cruel tenants which inhabit it. At length
a fchool-boy carelefs of his fafety, ventures to en-
ter this fubterraneous cavern, when ! to his great
delight, he finds nothing in it but the fame kind of
{tones and water he left behind him upon the fur-
face of the earth. In like manner, 1 have found
no other principles neceffary to explain the caufe
of the gout, and no other remedies neceflary to
cure it, than fuch as are admitted in explaining the
caufes, and in prefcribing, for the moll fimple and
common difeafes.

OBSERVATIONS

UPON THE

NATURE AND CURE

OF THE

HYDROPHOBIA.

OBSERVATIONS, &c.

N entering upon the confideration of this formi-
dable difeafe, I feel myfelf under an involuntary im-
preflion fomewhat like that which was produced by
the advice the king of Syria gave to his captains
when he was conducting them to battle. " Fight
not with fmall, or great ; fave only with the king
of Ifrael."* — In whatever light we contemplate
the hydrophobia, it may be confldered as pre-emi-
nent in power and mortality, over all other dif-
eafes.

It is now many years fince the diftrcfs, and horror
Q^ 2 excited

* Chron. H. chap, xviii. 30.

212 OBSERVATIONS ON

excited by it, both in patients and their friends, led
me with great folicitude to inveftigate its nature. I
have at length fatisfied myfelf with a theory of it
which I hope will lead to a rational, and fuccefsful
mode of treating it.

For a hiftory of the fymptoms of the difeafe, and
many interefting facts connected with it, I beg leave
to refer the reader to Dr. Meafe's learned and inge-
nious inaugural dhTertation publifhed in the year
1792.

The remote and exciting caufes of the hydropho-
bia are as follow.

1. The bite of a rabid animal. Wolves, foxes,
cats, as well as dogs impart the difeafe. It has been
faid that blood mult be drawn in order to produce
it, but I have heard of a cafe in Lancafter county in
Pennfylvania, in which a fevere contufign, by the
teeth of the rabid animal, without the effufion of a
drop of red blood, excited the difeafe. Happily
for mankind it cannot be communicated by blood, or
faliva falling upon found parts of the body. In Ma-
ryland the negroes eat with fafety the flefh of hogs
that have perifhed from the bite of mad dogs, and
I Lave heard of the milk of a cow at Cheftertown in
the fame ftate, having been ufed without any incon-
venience

tHE HYDROPHOBIA. 2l£

venience by a whole family on the very day in which
fhe was affected by this difeafe, and which killed her
in a few hours. Dr. Baumgarten confirms thefe facts
by faying that " the flefli and milk of rabid animals
have been eaten with perfect impunity.

>>#

In the following obfervations I (hall confine myfelf
chiefly to the treatment of the hydrophobia which
arifes from the bite of a rabid animal, but I fliall
add in this place a fhort account of all its other
caufes.

2. Cold night air. Dr. Arthaud late prefident
of the fociety of Philadelphians in St. Domingo, has
publifhed feveral cafes in which it was produced in
negroes by fleeping all night in the open air.

3. A wound in a tendinous part.

4. Putrid and impure animal food.

5. Worms. 6. Eating beach nuts. 7. Great
third. 8. Fear. 9. Involuntary aflbciation of ideas.
10. Hyfleria. 11. The tetanus. 12. The hydro-
cephalus. Of the prefence of hydrophobia in the
hydrocephalic flate of fever, there have been feveral
inftances in Philadelphia. 13. The typhus fever.

Dr.

* Medical Commentaries, Philadelphia edition, vol. 7. p. 409.

214 OBSERVATIONS ON

Dr. Trotter mentions the hydrophobia as a fymp-
tom which frequently occurred in the typhus ftate of
fever in the Britifh navy.* It is taken notice of like-
wife in a putrid fever by Dr. Cofte.f Vanfwieten
defcribes a cafe of it which fucceeded a dyfentery,J
and Dr. Griffitts obferved it in a high degree in a
young Lady who died of the yellow fever in 1793.

The dread of water, from which this difeafe de-
rives its name, has five diftincT: grades. 1. It can-
not be drunken. 2. It cannot be touched. 3. The
found of it in pouring from one veifel to another,
4. the fight of it, and 5. even the naming of it, can-
not be borne, without exciting convulfions. But
this fymptom is not an univerfal one. Dr. Mead
mentions three cafes in which there was no dread of
water in perfons who received the difeafe from the
bite of a rabid animal. It is unfortunate for this dif-
eafe as well as many others, that a fmgle fymptom
fhould impofe names upon them : In the prefent in-
ftance, it has done great harm, by fixing the attention
of phyficians fo exclufively upon the dread of water,
which occurs in it, that they have in a great mea-
fure overlooked every other circumilance which

belongs

* Medicina Nautica, p. 301.

f Medical Commentaries, Dobfon's edition, vol. ii. p. 476,

J Vol. xi. p. 144.

THE HYDROPHOBIA. 11$

belongs to the difeafe. The theory of the hydro-
phobia which an examination of its caufes, fymp-
toms, and accidental cures with all the induftry I was
capable of, has led me to adopt is, that it is a ma-
lignant state of fever. My reafons for this
opinion are as follow.

i. The difeafe in all rabid animals is a fever.
This is obvious in dogs who are mofl fubjecl: to it.
It is induced in them by the ufual caufes of fever,
fuch as fcanty or putrid aliment,* extreme cold,
and the fudden action of heat upon their bodies.
Proofs of its being derived from each of the above
caufes, are to be met with in mofl of the authors
who have written upon it. The animal matters
which are rendered morbid by the action of the
above caufes upon them, are determined to the fali-
va, in which a change fcems to be induced, fimilar
to that which takes place in the perfpirable matter
of the human fpecies from the operation of fimilar
caufes upon it. This matter it is well known is
the remote caufe of the jail fever and the plague.
No wonder the faliva of a dog fliould produce a

difeafe

* " Animal food in a ftate of putridity, is amongft the
mofl frequent caufes of canine madnefs."

Young's Annals, vol. xvii. p. 561.

2l6 OBSERVATIONS ON

difeafe of the fame kind, after being vitiated by
the fame caufes, and thereby difpofed to produce
the fame effects. 2. The difeafe called canine mad-
nefs, prevails occafionally among dogs at thofe times
in which malignant fevers arc epidemic. This will
not furprife thofe perfons who have been accuftomed
to obferve the prevalence of the influenza and bi-
lious fevers among other domeflic animals at a time
when they are epidemic among the human fpecies.
Dr. James and Sir Theodore Mayerne afTert, that
the difeafe among dogs is propagated by contagion.
Dr. James fays that it has been communicated by
the miafmata left by them in a kennel. I believe
this to be poflible, for the analogy of the hydro-
phobia with the fmall pox, in fo many particulars,
favours the idea that it may be propagated as well
through the medium of the air, as by the mixture
of the faliva of the difeafed dog with the blood.
3. Dogs when they are faid to be mad, exhibit the
ufual fymptoms of fever, fuch as a want of appe-
tite, great heat, a dull, fierce, red, or watery eye,
indifpofition to motion, fleepinefs, delirium, and
madnefs. The fymptom of madnefs is far from
being univerfal, and hence many dogs are difeafed
and die with this malignant fever, that areinoffen-
five, and inftead of biting, continue to fawn upon
their maflers. Nor is the difpofition of the fever to
communicate itfelf by infection univerfal among

dogs

THE HYDROPHOBIA. 21/

dogs any more than the fame fever in the human
fpecies, and this I fuppofe to be one reafon why
many people are bitten by what are called mad
dogs, who never fufFer any inconvenience from it.
4. A dhTection of a dog, by Dr. Cooper, that died
with this fever, exhibited all the ufual marks of
inflammation and effufion which take place in com-
mon malignant fevers. 1 fhall in another place
mention a fifth argument in favour of the difeafe
in dogs being a malignant fever, from the efficacy
of one of the mod powerful remedies in that ftate
of fever, having cured it in two inflances.

II. The difeafe produced in the human fpecies
by the bite of a rabid animal is a malignant fever.
This appears firft from its fymptoms. Thefe, as
recorded by Aurelian, Mead, Fothergill, Plummer,
Arnold, Baumgarten, and Morgagni, are chills,
great heat, thirft, naufea, a burning fenfation in the
ftomach, vomiting, coflivenefs — a fmall, quick, tenfe,
irregular, intermitting, natural, or flow pulfe — a
cool ikin, great fenfibility to cold air, partial cold
and clammy fweats on the hands, or fweats accom-
panied with a warm fkin diffufed all over the body,
difficulty of breathing, fighing, reftleflhefs, hiccup,
giddinefs, head-ache, delirium, coma, falfe vifion,
dilatation of the pupils, dulnefs of fight, blindnefs,
glandular fwellings, heat of urine, priapifm, palpi-
tation

21$ OBSERVATIONS ON

tation of the heart, and convulfions. — I know that
there are cafes of hydrophobia upon record in which
there is faid to be a total abfence of fever. The
fame thing has been faid of the plague. In both
cafes the fuppofed abfence of fever is the effect of
flimulus acting upon the blood -veffels with fo much
force as to fufpend morbid action in them. By ab-
ftracting a part of this ftimulus, a fever is excited
which foon difcovers itfelf in the pulfe and on the
ikin, and frequently in pains in every part of the
body. The dread of water, and the great fenfibi-
lity of the fyftem to cold air, are faid to give a fpe-
cific character to the hydrophobia 5 but the former
fymptom, it has been often feen, occurs in difeafes
from other caufes, and the latter has been frequently
obferved in the yellow fever. It is no more extra-
ordinary that a fever excited by the bite of a rabid
animal mould excite a dread of water, than that
fevers from other caufes mould produca averfion
from certain aliments, from light, and from founds
of all kinds ; nor is it any more a departure from
the known laws of ftimulants, that the faliva of a
mad dog mould affect the fauces, than that mercu-
ry mould affect the falivary glands. Both flimuli
appear to act in a fpecific manner.

2. The hydrophobia partakes of the character
of a malignant fever in appearing at different in-
tervals

THE HYDROPHOBIA. 219

tervals from the time in which the infection is re-
ceived into the body. Thefe intervals are from
one day to five or fix months. The fmall pox
(hews itfelf in intervals from 8 to 20 days, and
the plague and yellow fever from the moment in
which the contagion is inhaled, to nearly the fame
diftance of time. This latitude in the periods at
which infectious and contagious matters are brought
into action in the body, mufl be refolved into the
influence which the.feafon of the year, the habits
of the patients, and the pailion of fear have upon
them.

Where the interval between the time of being
bitten, and the appearance of a dread of water,
exceeds five or fix months, it is probable it may be
occafioned by a difeafe derived from another caufe.
Such a perfon is predifpofed in common with other
people to all the difeafes of which the hydropho-
bia is a fymptom. The recollection of the poifon-
ous wound he has received, and its ufual confe-
quences, is feldom abfent from his mind for months
or years. A fever, or an affection of his nerves
from their mofl common caufes, cannot fail of ex-
citing in him apprehenfions of the difeafe which
ufually follows the accident to which he has been
expofed. His fears are then let loofe upon his.
fyftem, and produce in a fhort time a dread of

water

220 OBSERVATIONS OK

water which appears to be wholly unconnected
with the bite of a rabid animal. Similar inftances
of the effects of fear upon the human body are to
be met with in books of medicine. The pains pro-
duced by fear acting upon the imagination in fup-
pofed venereal infections, are as real and fevere as
they are in the word ftate of that difeafe.

3. Blood drawn in the hydrophobia exhibits
the fame appearances which have been remarked
in malignant fevers. In Mr. Bellamy, the gentle-
man whofe cafe is fo minutely related by Dr. Fo-
thergill, the blood difcovered with cc flight traces
of fize, ferum remarkably yellow" It was uncom-
monly fizy in a boy of Mr. George Oakley's whom
I faw, and bled for the firfl time, on the fourth day
of his difeafe in the beginning of the year 1797.
His pulfe imparted to the fingers the fame kind of
quick and tenfe flroke which is common in the open
forms of the yellow fever. He died in convulfions
the next day. He had been bitten by a mad dog
on one of his temples, three weeks before he dif-
covered any figns of indifpofition.

4. The hydrophobia accords exactly with malig-
nant fevers in its duration. It generally terminates
in death, according to its violence, and the habit
of the patient on the firfl, fecond, third, fourth

THE HYDROPHOBIA. 221

0r fifth day, from the time of its attack, and with
the fame fymptoms which attend the laft ftage of
malignant fevers.

5. The body after death, from the hydrophobia,
putrefies with the fame rapidity, that it does after
death from a malignant fever in which no depletion
has been ufed.

6. DifTectJons of bodies which have died of the
hydrophobia, exhibit the fame appearances which
are obferved in the bodies of perfons who have
perifhed of malignant fevers. Thefe appearances,
according to Morgagni and Tauvry,* are marks of
inflammation in the throat, cefophagus, brain, fto-
mach, liver, and bowels. Effufions of water, and
congeftions of blood in the brain, large quantities
of dark coloured or black bile in the gall-bladder
and ftomach — mortifications in the bowels and blad-
der— livid fpots on the furface of the body — and
above all, the arteries filled with fluid blood, and
the veins nearly empty. I am aware that two cafes
of death from hydrophobia, are related by Dr.
Vaughan, in which no appearance of difeafe wras
difcovered by difTection in any part of the body.
Similar appearances have occafionally been met with

* Bibliotkeque Choifle de Medecine, tome xv. p. 210.

222 OBSERVATIONS ON

in perfons who have died of malignant fevers. I
have explained them in my lectures by calling the
attention of my pupils to what conftituted a dif-
eafe. It is morbid action. Now this action is
often fo violent as to prevent inflammation.* We
err therefore when we place difeafe in inflammation,
for it is one of its primary effects only, and hence
we obferve it does not take place in many inflances
in malignant fevers until the arteries are fo far re-
laxed by two or three bleedings as to be able to re-
lieve themfelves by effufing red blood into ferous
veffels, and thus to produce that error loci which
I have elfewheref fuppofed to be elTential to in-
flammation. The exiflence of this grade of action
in the arteries may always be known by the pre-
fence of iizy blood, and by the more obvious and
common fymptoms of fever.

* In the 6th volume of the Medical Obfervations and In-
quiries, there is an account of a diffection of a perfon who
had been destroyed by taking opium. " No morbid appear-
" ance (fays Mr. Whateley, the furgeon who opened the
" body) was found in any part of the body, except that
" the villous coat of the ftomach was very flightly inflamed."
The ftimulus of the opium in this cafe either produced an
action which tranfeended inflammation, or deftroyed action
altogether by its immenfe force, by which means the more
common morbid appearances which follow difeafe in a dead
body could not take place.

f Medical Inquiries and Obfervations, vol. iv.

■ tfl THE HYDROPHOBIA. 22^

h\ addition to the explanation which has been
given of the term difeafe, and of the difference
between it and inflammation, I have defignated that
deranged flate of any part of the body which fuc-
ceeds difeafe, whether it be inflammation, obftruc-
tion, effufion, .or^gangrene, by the name of dif-
order. . /To render this divifion of caufes and effects
in pathology, more fimple and intelligible, it is ne-
ceffary to remark further, that they do not always
exift alone and unconnected with each other. Some
remains of predifpofing debility occafionally cleave
to difeafe, and diforders are fometimes formed be-
fore the morbid actions of difeafe have completely
fpent themfelves. Thus we fee cold feet from debi-
lity, with the figns of violent difeafe in the pulfe in
the yellow fever, and univerfal difeafe in the blood-
veffels, with a fixed diforder from tubercles in the
pulmonary confumption.

The remedies for hydrophobia, according to the
principles I have endeavoured to eftablifh, divide
themfelves naturally into two kinds.

I. Such as are proper to prevent the difeafe, after
the infection of the rabid animal is received into
the body.

II. Such as are proper to cure it when formed.

The

224 OBSERVATIONS ON

The firfl: remedy under the firft general head is,
abftrafting or deftroying the virus, by cutting or
burning out the wounded part, or by long and
frequent eftufions of water upon it agreeably to the
advice of Dr. Haygarth, in order to wafh the faliva
from it. The fmall pox has been prevented, by
cutting out the part in which the puncture was
made in the arm with variolous matter. There is
no reafon why the fame practice mould not fucceed,
if ufed in time in the hydrophobia. Where it has
failed of fuccefs, it has probably been ufed after
the poifon has contaminated the blood. The
wound mould be kept open and running for fe-
veral months. In this way a fervant girl who was
bitten by the fame cat that bit Mr. Bellamy, is fup-
pofed by Dr. Fothergill to have efcaped the dif-
eafe. Dr. Weflon of Jamaica believes that he
prevented the difeafe by the fame means in two in-
ftances. Perhaps an advantage would arife from
exciting a good deal of inflammation in the wound.
We obferve after inoculation, that the more inflam-
ed the puncture becomes, and the greater the dif-
charge from it, the lefs fever and eruption follow
in the fmall pox.

A fecond preventive is a low diet, fuch as has
been often ufed with fuccefs to mitigate the plague
and yellow fever. The fyftem in this cafe, bends be-
neath

THE HYDROPHOBIA. 22J

neath the ftimulus of the morbid faliva, and thus ob-
viates or leffens its effects at a future day.

During the ufe of thefe means to prevent the dif-
eafe, the utmoft care ihould be taken to keep up
our patient's fpirits, by infpiring confidence in the
remedies prefcribed for him.

Mercury has been ufed in order to prevent the dil-
eafe. There are many well attefted cafes upon re-
cord of perfons who have been falivated after being
bitten by mad animals in whom the difeafe did not
fhew itfelf, but there are an equal number of cafes
to be met with, in which even a falivation did not
prevent it. From this it would feem probable, that
the faliva did not infect: in the cafes in which the
difeafe was fuppofed to have been prevented by the
mercury. At the time calomel was ufed to prepare
the body for the fmall pox, a falivation was often in-
duced by it. The affection of the falivary glands in
many inflances leffened the number of pock, but I
believe in no inflance prevented the eruptive fever.

I mall fay nothing here of the many other medi-
cines which have been ufed to prevent the difeafe.
No one of them has I believe done any more good,

than
R

226 OBSERVATIONS ON

than the boafled fpecifics which have been uftd to
eradicate the gout, or to procure old age. They
appear to have derived their credit from fome of the
following circumflances accompanying the bite of
the animal.

i. The animal may have been angry, but not dif-
eafed with a malignant fever fuch as I have defcrib-
ed.

2. He may have been difeafed, but not to fuch a
degree as to have rendered his faliva infectious.

3. The faliva when infectious, may have been fo
warned off in pafling through the patient's clothes, as
not to have entered the wound made in the flefti.
And

4. There may have been no predifpofition in the
patient to receive the fever. This is often obferved
in perfons expofed to the contagion of the plague,
yellow fever, fmall pox, and to the infection of the
itch, and the venereal difeafe.

The hydrophobia like the fmall pox generally
comes on with fome pain, and inflammation in the

part

THE HYDROPHOBIA. 227

part in which the infection was infufcd into the body,
but to this remark, as in the fmall pox there are fome
exceptions. As foon as the difeafe difcovers itfelf,
whether by pain or inflammation in the wounded
part, or by any of the fymptoms formerly, the firft
remedy indicated is blood-letting. Ail the facts
which have been mentioned, relative to its caufe,
fymptoms, and the appearances cf the body after
death, concur to enforce the ufe of the lancet in this
difeafe. Its affinity to the plague and yellow fever
in its force, is an additional argument in favor of
that remedy. To be effectual, it fhould be ufed in
the mod liberal manner. The lofs of 100 to 200
ounces of blood will probably be neceflfary in mod
cafes to effect a cure. The pulfe fhould govern the
ufe of the lancet as in other ftates of fever, taking
care not to be impofed upon by the abfence of fre-
quency in it, in the fuppofed abfence of fever, and of
ten/ton in affections of the ftomach, bowels and brain.
This practice in the extent I have recommended it,
isjuflificd not only by the theory of the difeafe, but
by its having been ufed with fuccefs in the following
cafes.

Dr. Nugent cured a woman by two copious bleed-
ings, and afterwards by the ufe offweating and cor-
dial medicines.

Mr.

228 OBSERVATIONS ON

Mr. Wrightfon was encouraged by Dr. Nugent's
fuccefs to life the fame remedies with the fame hap-
py hTucin a boy of 15 years of age.*

Mr. Falconer, cured a young woman of the name
of Hannah Moore by " a copious bleeding," and
another depleting remedy to be mentioned here-
after.!

Mr. Poupart cured a woman by bleeding until
flie fainted, and Mr. Berger gives an account of a
number of perfons being bitten by a rabid animal
all of whom died, except two who were faved by
bleeding. I

Dr. Marfillac has favoured me with the hiftory
of a cafe of hydrophobia from the bite of a mad
dog, in which copious, and repeated bleedings di-
rected by Dr. Lc Compt in France in the year 1786,
performed a perfect cure in five weeks. — The bleed-
ings were aided by another medicine to be mention-
ed in its proper place.

In the 40th volume of the Tranfactions of the
Royal Society of London, there is an account of

a man

* Medical TranfacHons, vol. ii. p. 192.
f Ditto, p. 222.
% Bibliothsque Choifie de Medccine. Tome x v. p. 212.

THE HYDROPHOBIA. 229

a man being cured of hydrophobia by Dr. Hartley
by the lofs of uo ounces of blood.

Dr. Tilton cured this difeafe in a woman in the
Delaware ftate by very copious bleeding. The
remedy was fuggefled to the Doctor by an account
taken from a London Magazine of a dreadful hy-
drophobia being cured by an accidental and profufe
hemorrhage from the temporal artery.*

A cafe is related by Dr. InneSjf of the lofs of
1 1 6 ounces of blood in feven days having cured
this difeafe. In the patient who was the fubject of
this cure, the bleeding was ufed in the mod: de-
preffed, and apparently weak ftate of the pulfe.
It rofe conftantly with the lofs of blood.

The • two laft of the above cafes were faid to be
of a fpontaneous nature, but the morbid actions
were exactly the fame in both patients with thofe
which are derived from the bite of a rabid animal.
There is but one remote caufe of difeafe, and
that is ftimulus, and it is of no confequence in the
difeafe now under confideration, whether the dread
of water be the effect of the faliva of a rabid ani-
mal

* Medical EfTays of Edinburgh, vol. i. p. 226.
f Medical Commentaries, vol. iii. p. 496.

2$Q OBSERVATIONS ON

mal acting upon the fauces, or of a morbid excite-
ment determined to thofe parts by any other ftimu-
lus. The inflammation of the ftomach, depends
upon the fame kind of morbid action, whether it
be produced by the contagion of the yellow fever,
or the ufual remote and exciting caufes of the
gout. An apoplexy is the fame difeafe when it
arifes from a contufion by external violence, that
it is when it arifes fpontaneoufly from the congeflion
of blood, or water in the brain. A dropfy from
obit ructions in the liver induced by ftrong drink,
does not differ in its proximate caufe from the
dropfy brought on by the obftructions in the fame
vifcus which are left by a neglected, or half cured
bilious fever. Thefe remarks are of extenfive ap-
plication, and if duly attended to, would deliver
us from a mafs cf error which has been accumu-
lating for ages in medicine ; I mean the nomencla-
ture of difeafes from their remote caufes. It is the
moil oitenilve and injurious part of the rubbifh of
oar Science.

I grant that bleeding has been ufed in fome in-
stances in hydrophobia without eJecl, but in all
foch cafes, it was probably ufed out of time, or in
too fparing a manner. The credit of this remedy
has fuffered in many other difeafes from the fame
caufes. 1 beg it may not be tried in this difeafe,

Tils HYDROPHOBIA. 23 1

by any phyfician who has not renounced our mo-
dern fyftems of nofology, and adopted in their ut-
mofl extent the principles, and practice of Botallus
and Sydenham in the treatment of malignant
fevers.

Before I quit the fubject of blood-letting in hy-
drophobia, I have to add, that it has been ufed
with fuccefs in two inftances in dogs that had ex-
hibited all the ufual fymptoms of what has been
called madnefs. In one cafe, blood was drawn by
cutting off the tail, in the other, by cutting off
the ears of the difcafed animal. I mention thefe
facts with pleafure, not only becaufe they ferve to
fupport the theory and practice which I have en-
deavoured to eftablifh in this difeafe, but becaufe
they will render it unneceffary to deflroy the life
of a ufeful and affectionate animal in order to
prevent his fpreading it. By curing it in a dog
by means of bleeding, we moreover beget confi-
dence in the fame remedy in perfons who have been
bitten by him, and thus leffen the force of the
difeafe, by preventing the operation of fear upon
the fyftem.

2. Purges, and glyfters have been found ufeful
-in the hydrophobia. They difcharge bile which is
frequently vitiated, and reduce morbid action in the

flomach

232 OBSERVATIONS ON

flomach and blood-veffels. Dr. Cofle afcribes the
cure of a young woman in a convent wholly to
glyflers given five or fix times every day.

3. Sweating after bleeding completed the cure
of the boy whofe cafe is mentioned by Mr. Wright-
fon. Dr. Baumgarten fpeaks highly of this mode
of depleting, and fays further, that it has never
been cured cc but by evacuations of fome kind."

4. All the advantages which attend a falivation
in common malignant fevers, are to be expected
from it in the hydrophobia. It aided blood-letting
in two perfons who where cured by Mr. Falconer
and Dr. Le Compt.

There are feveral cafes upon record in which mu/k
and opium have afforded evident relief in this dif-
eafe.

A phyfician in Virginia cured it by large dofes of
bark and wine. I have no doubt of the efficacy of
thefe remedies when the difeafe is attended with a
moderate or feeble morbid action in the fyflem, for I
take it for granted, it refembles malignant fevers
from other caufes in appearing in different grades of
force. In its more violent and common form, fin
mulants of all kinds muft do harm, unlefs they are

THE HYDROPHOBIA. 233

of fuch a nature, and exhibited in fuch quantities,
as to exceed in their force the ftimulus of the difeafe,
but this is not be expected, more efpecially as the
flomach is for the mod part fo irritable as fometimes
to reject the mildeft aliments as well as the mod
gentle medicines.

After the morbid anions in the fyftem have been
weakened, tonic remedies would probably be ufeful
in accelerating the cure.

Blifters, and ftimulating cataplafms applied to the
feet might probably be ufed with the fame advan-
tage in the declining flate of the difeafe, that they
have been ufed in the fame flage of other malignant
fevers.

The cold bath, alfo long immerfion in cold water,
have been frequently ufed in this difeafe. The for-
mer aided the lancet in the cure of the man whofe
cafe is related by Dr. Hartley. There can be no
objection to the cold water in either of the above
forms, provided no dread is excited by it in the
mind of the patient.

The reader will perceive here that I have deferted
an opinion at which I hinted in my obfervations up-
on
S

234' OBSERVATIONS ON

on the caufe and cure of the tetanus.* I there
fuppofed the hydrophobia to depend upon debility*
This debility I hzvm iince been led to confider as par-
tial, depending upon abftra&ion of excitement from
fome, and a morbid accumulation of it in other
parts of the body. In the former, it is of a direct,
in the latter, it is of an indirect nature. The pre-
ternatural excitement predominates fo far in moil
cafes of hydrophobia over direct weaknefs, that de-
pleting remedies promife more fpeedily and fafely to
equalize, and render it natural, than medicines of
an oppofite character.

In the treatment of thofe cafes of hydrophobia
which are not derived from the bite of a rabid ani-
mal, regard fhould always be had to its remote and
exciting caufes, fo as to accommodate the remedies
to them. I ilia.ll only mention in the hiftory of a
cafe, the remedy for that flate of hydrophobia
which arifes from fear.

A clergyman in a neighbouring ftate lately vifit-
ed one of his parifhioners who was haflening to the
grave with the hydrophobia from the bite of a
mad dog. In converfing with him, he inadvertent-
ly took up a pipe of tobacco which the diffracted
and dying man had juft laid down, and put it into

his

* Medical Inquiries and Obfervations vol. i.

THE HYDROPHOBIA. 2$$

his mouth. When he came home, he recollected this
incident. The thoughts of it filled him with terror,
and he was foon afterwards affected with a difficul-
ty of fwallowing and dread of water. The elders
of his church were fent for to confole him. A phy-
ikian was likewife fent for, who took a part in the
convention of his patient with his friends. His
opinions however upon the fubjects on which they
converfed, which were of a. religious nature, were
fo offcnfive to the clergyman, that he was thrown
into a paffion in hearing and refuting them, by
which means his hydrophobia was inftantly cured.
In this way the impulfe of powerful emotions and
pailions often cure difeafes of lefs force, both in
the body and mind.

The imperfection of the prefent nomenclature of
medicine has become the fubject of general com-
plaint. The mortality of the difeafe from the bite
of a rabid animal, has been increafed by its name.
The terms hydrophobia and canine madnefs, con-
vey ideas of the fymptoms of the difeafe only,
and of fuch of them too, as are by no means uni-
verfal. If the theory I have delivered, and the
practice I have recommended be jutt, it ought to
be called the hydrophobic flate of fever. This
name affociates it at once with all the other ftates
of fever, and leads us to treat it with the remedies

which

2$6 OBSERVATIONS ON

which are proper in its kindred difeafes, and to
vary them conftantly with the varying (late of the
lyitem.

In reviewing what has been faid of this difeafe,
I dare not fay that I have not been mifled by the
principles of fever which I have adopted ; but if
I have, I hope the reader will not be difcouraged
by my errors from ufmg his reafon in medicine.
By contemplating thofe errors, he may perhaps
avoid the fhoals upon which I have been wrecked.
In all his refearches, let him ever remember that
there is the fame difference between the knowledge
of a phyfician who prefcribes for difeafes as limited
by genera and fpecies, and of one who prefcribes
tinder the dire&ion of juft principles, that there is
between the knowledge we obtain of the nature
and extent of the iky, by viewing a few feet of it
from the bottom of a well, and viewing from the
top of a mountain, the whole canopy of heaven.

I N I

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